HIV/AIDS Bureau, Division of Metropolitan HIV/AIDS Programs
National Monitoring Standards for Ryan White Part A Grantees:
Program – Part A
Table of Contents
Section A: Allowable Uses of Part A Service Funds
Section B: Core Medical Services
Section C: Support Services
Section D: Quality Management
Section E: Administration
Section F: Other Service Requirements
Section G: Prohibitions and Additional Requirements
Section H: Chief Elected Official (CEO) Agreements & Assurances
Section I: Minority AIDS Initiative
Standard
Performance Measure/
Method
Grantee
Responsibility
RFP, contracts, MOU/LOA, and/or
statements of work language that
describes and defines Part A
services within the range of
activities and uses of funds allowed
under the legislation and defined in
Include RFP, contracts,
MOU/LOA, and/or
statements of work
language that allows
use of Part A funds only
for the provision of
Provider/Subgrantee
Responsibility
Source
Citation
Section A:
Allowable Uses of Part A
Service Funds
1. Use of Part A funds only to
support:
• Core medical services
• Support services that are
needed by individuals
with HIV/AIDS to achieve
1
• Provide the services
described in the RFP,
contracts, MOU/LOA,
and/or statements of
work Bill only for
allowable activities
PHS ACT 2604
1
(a)(2)
HAB Policy
Notices 97-01,
97-02, and 10-
All statutory citations are to title XXVI of the Public Health Service Act, 42 U.S.C. § 300ff-11 et seq, and are abbreviated with “PHS ACT XXX” and the section reference.
1
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
•
•
medical outcomes related
to their HIV/AIDS-related
clinical status
Clinical quality
management
Administrative activities
(including Planning
Council support)
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
• Maintain in files, and
share with the grantee
on request,
documentation that
only allowable activities
are being billed to the
Part A grant
Source
Citation
02
HRSA HAB Policy Notices
including core medical and support
services, clinical quality
management and administration
(including Planning Council
support)
services and activities
allowed under the
legislation and defined
in referenced HAB
Policy Notices
Documentation of the following:
• Care is provided by health care
professionals certified in their
jurisdictions to prescribe
medications in an outpatient
setting such as a clinic, medical
office, or mobile van
• Only allowable services are
provided
• Services are provided as part of
the treatment of HIV infection
• Specialty medical care relates to
HIV infection and/or conditions
arising from the use of HIV
medications resulting in side
effects
• Services are consistent with
HHS Guidelines
• Service is not being provided in
an emergency room, hospital or
any other type of inpatient
PHS ACT 2604
• Include the
• Ensure that client
(c)(3)(A)
definition, allowable
medical records
services, and
document services
limitations of
provided, the dates and
outpatient
frequency of services
ambulatory medical
provided, that services
services in the RFP,
are for the treatment of
contracts,
HIV infection
MOU/LOA, and/or
• Include clinician notes
statements of work
in patient records that
Require subgrantees
are signed by the
to provide
licensed provider of
assurances that care
services
is provided only in
• Maintain professional
an outpatient setting,
certifications and
is consistent with
licensure documents
HHS Guidelines, and
and make them
is chronicled in client
available to the grantee
medical records
on request
• Review client
medical records to
ensure compliance
2
Dr. ParhamHopson Letter
8/14/09, 4/8/10
Section B: Core Medical
Services
1. Provision of Outpatient and
Ambulatory Medical Care,
defined as the provision of
professional diagnostic and
therapeutic services rendered
by a licensed physician,
physician's assistant, clinical
nurse specialist, or nurse
practitioner in an outpatient
setting (not a hospital, hospital
emergency room, or any other
type of inpatient treatment
center), consistent with HHS
guidelines and including
access to antiretroviral and
other drug therapies, including
prophylaxis and treatment of
opportunistic infections and
combination antiretroviral
therapies
• Allowable services include:
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
• Diagnostic testing
• Early intervention and risk
assessment,
• Preventive care and screening
• Practitioner examination,
medical history taking,
diagnosis and treatment of
common physical and mental
conditions
• Prescribing and managing of
medication therapy
• Education and counseling on
health issues
• Well-baby care
• Continuing care and
management of chronic
conditions
• Referral to and provision of
HIV-related specialty care
(includes all medical
subspecialties even
ophthalmic and optometric
services)
1. As part of Outpatient and
Ambulatory Medical Care,
provision of laboratory tests
integral to the treatment of
HIV infection and related
complications
Performance Measure/
Method
treatment center
Documentation that tests are:
• Integral to the treatment of HIV
and related complications,
necessary based on established
clinical practice, and ordered by
a registered, certified, licensed
provider
• Consistent with medical and
laboratory standards
• Approved by the Food and Drug
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
with contract
conditions and Ryan
White program
requirements
• Review the licensure
of health care
professionals
providing ambulatory
care
• Include the HRSA
approved service
category definition,
requirements, and
limitations of testing
in medical services
contract
• Develop and share
with providers a
listing of laboratory
Document, include in
client medical records,
and make available to the
grantee on request:
• The number of
laboratory tests
performed
• The certification,
licenses, or FDA
approval of the
HAB Policy
Notice 07-02
3
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
2. Part A funding allocated to a
State-supported AIDS Drug
Assistance Program (ADAP)
that provides an approved
formulary of medications to
HIV-infected individuals for
the treatment of HIV disease
or the prevention of
opportunistic infections,
based on income guidelines
and Federal Poverty Level
(FPL) set by the State
Performance Measure/
Method
Grantee
Responsibility
Administration (FDA) and/or
Certified under the Clinical
Laboratory Improvement
Amendments (CLIA) Program
tests that meet these
definitions
• Document the
number of laboratory
tests performed
• Review client records
to ensure
requirements are
met and match
quantity of tests with
reports
Review State
documentation that the
ADAP program
receiving funds from
the Part A program
meets federal
requirements, including:
o Use of an
approved medical
formulary based
on purchase of
HIV medications
included in the list
of classes of core
antiretrovirals for
eligible clients in
a cost-effective
manner
o Use of
medications that
are FDAapproved
Documentation of the following:
• A medication formulary that
includes pharmaceutical agents
from all the classes approved in
HHS Clinical Practice
Guidelines for use of
Antiretroviral Agents in HIV-1
infected Adults and
Adolescents
• A medication formulary that
meets the minimum
requirements from all approved
classes of medications
according to HHS treatment
guidelines.
• Policies and procedures for
access, monitoring, and assure
adherence to 5-10 percent of
the State’s total ADAP funding
• An eligibility process requiring
documentation in client medical
records of low-income status
Provider/Subgrantee
Responsibility
Source
Citation
laboratory from which
tests were ordered
• The credentials of the
individual ordering the
tests
• Provide to the Part A
grantee, on request,
documentation that the
ADAP program meets
HRSA/HAB
requirements
• Maintain
documentation, and
make available to the
Part A grantee on
request, proof of client
ADAP eligibility that
includes HIV status,
EMA/TGA residency,
and low- income status
as defined by the State
based on a specified
percent of the FPL
• Provide reports to the
Part A program of
number of individuals
served and the
PHS ACT
2604 (c)(3)(B)
PHS ACT 2616
(e)
HAB Policy
Notice 00-02
4
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Performance Measure/
Method
Standard
•
3. Implementation of a Local
AIDS Pharmaceutical
and eligibility based on a
specified percent of the FPL
and proof of an individual’s
HIV-positive status, residency.
A process used to secure the
best price available for all
products including 340B pricing
or better
• Documentation that the (LPAP)
program’s drug distribution
Grantee
Responsibility
Provider/Subgrantee
Responsibility
o Use of Federal
funds to match
and expand the
purchase of HIV
medications and
not displace State
funding for the
same purpose
o Determination
and
documentation of
client eligibility at
least every six
months
• Require reporting on
client eligibility,
clients served, and
medications
provided
medications provided
Note: In cases where
Part A contributes to
the State ADAP, the
State becomes a Part A
provider and must
provide documentation
to the Part A Program
to ensure allowable use
of funds, report costs,
and ensure client
eligibility
• Include a statement
of need in RFP,
• Provide to the Part A
grantee, on request,
Source
Citation
PHS ACT
2604 (c)(3)(C)
5
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Assistance Program (LPAP) for
the provision of HIV/AIDS
medications using a drug
distribution system that has:
• A client enrollment and
eligibility determination
process that includes
screening for ADAP and
LPAP eligibility with
rescreening every six months
• A LPAP advisory board
• Uniform benefits for all
enrolled clients throughout
the EMA or TGA
• A drug formulary approved by
the local advisory
committee/board
• A recordkeeping system for
distributed medications
• A drug distribution system
An LPAP that does not dispense
medications as:
• A result or component of a
primary medical visit
• A single occurrence of short
duration (an emergency)
• Vouchers to clients on an
emergency basis
A Program that is:
• Consistent with the most
current HIV/AIDS Treatment
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
system has:
o A client enrollment and
eligibility process that
includes screening for ADAP
and LPAP eligibility with
rescreening at least every six
months
o Uniform benefits for all
enrolled clients throughout
the EMA or TGA
o A LPAP advisory board
o A recordkeeping system for
distributed medications
o A drug distribution system
that includes a drug
formulary approved by the
local advisory
committee/board
contracts,
MOU/LOA, and/or
statements of work
Specify in RFP,
contracts,
MOU/LOA, and/or
scopes of work all
applicable federal,
state, and local
requirements for
pharmaceutical
distribution systems
and the geographic
area to be covered
Ensure that the
program:
Meets federal
requirements
regarding client
enrollment, uniform
benefits,
recordkeeping, and
drug distribution
process, consistency
with current
HIV/AIDS Treatment
Guidelines,
consistency with
payer of last resort
Has consistent
procedures/ systems
that account for
tracking and
documentation that the
LPAP program meets
HRSA/HAB
requirements
• Maintain
documentation, and
make available to the
Part A grantee on
request, proof of client
LPAP eligibility that
includes HIV status,
residency, medical
necessity, and lowincome status as
defined by the
EMA/TGA based on a
specified percent of the
Federal Poverty Level
(FPL)
• Provide reports to the
Part A program of
number of individuals
served and the
medications provided
HAB plans to
issue future
guidance
regarding this
service
category.
• Documentation that the LPAP is
not dispensing medications as:
o A result or component of a
primary medical visit
o A single occurrence of short
duration (an emergency)
without arrangements for
longer term access to
medication
o Vouchers to clients on a
single occurrence without
arrangements for longer-term
access to medications
• Documentation that the LPAP
•
•
•
•
6
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
•
Guidelines
Coordinated with the State’s
Part B AIDS Drug Assistance
Program
Performance Measure/
Method
Program is:
o Consistent with the most
current HIV/AIDS Treatment
Guidelines
o Coordinated with the State’s
Part B AIDS Drug Assistance
Program
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
reporting of
expenditures and
income, drug pricing,
client utilization,
client eligibility and
support clinical
quality management
• Defines the
geographic area
covered by the local
pharmacy program
The geographic area
must be either a
TGA/EMA or
consortium area
• Does not dispense
medication as the
result of a primary
care visit, in
emergency
situations or in the
form of medication
vouchers to clients
on a single
occurrence without
arrangements for
longer term access
to medications
• Review program files
to ensure that
distributed
medications meet
federal and contract
7
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
requirements
• Review client
3. Support for Oral Health
Services including
diagnostic, preventive, and
therapeutic dental care that is
in compliance with state
dental practice laws, includes
evidence-based clinical
decisions that are informed
by the American Dental
Documentation that:
• Oral health services are
provided by general dental
practitioners, dental specialists,
dental hygienists and auxiliaries
and meet current dental care
guidelines
• Oral health professionals
providing the services have
records to ensure
proper enrollment,
eligibility, uniform
benefits, no
dispensing of
medications for
unallowable
purposes, no
duplication of
services
• LPAPs need to be
implemented in
accordance with
requirements of the
340B Drug Pricing
Program, Prime
Vendor Program
and/or Alternative
Methods Project in
order to ensure “best
Price” to maximize
these resources.
• Develop a RFP,
contracts,
MOU/LOA, and/or
scopes of work for
the provision of oral
health that:
o Specify allowable
diagnostic,
preventive, and
•
Maintain a dental
record for each client
that is signed by the
licensed provider and
includes a treatment
plan, services
provided, and any
referrals made
PHS ACT
2604 (c)(3)(D)
8
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Association Dental Practice
Parameters, is based on an
oral health treatment plan,
adheres to specified service
caps, and is provided by
licensed and certified dental
professionals
Performance Measure/
Method
appropriate and valid licensure
and certification, based on
State and local laws
• Clinical decisions that are
supported by the American
Dental Association Dental
Practice Parameters
• An oral health treatment plan is
developed for each eligible
client and signed by the oral
health professional rendering
the services
• Services fall within specified
service caps, expressed by
dollar amount, type of
procedure, limitations on the
number of procedures, or a
combination of any of the above,
as determined by the Planning
Council or Grantee under Part A
Grantee
Responsibility
Provider/Subgrantee
Responsibility
therapeutic
•
services
o Define and
specify the
limitations or caps
on providing oral
health services
o Ensure that
services are
provided by
dental
professionals
certified and
licensed
according to state
guidelines
o Ensure that
clinical decisions
are informed by
the American
Dental
Association
Dental Practice
Parameters
• Review client
records and
treatment plans for
compliance with
contract conditions
and Ryan White
program
requirements
Source
Citation
Maintain, and provide
to grantee on request,
copies of professional
licensure and
certification
9
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
4. Support of Early
Intervention Services (EIS)
that include identification of
individuals at points of entry
and access to services and
provision of:
• HIV Testing and Targeted
counseling
• Referral services
• Linkage to care
• Health education and literacy
training that enable clients to
navigate the HIV system of
care
All four components must be
present, but Part A funds to be
used for HIV testing only as
necessary to supplement, not
supplant, existing funding
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Documentation that:
• Part A funds are used for HIV
testing only where existing
federal, state, and local funds
are not adequate, and Ryan
White funds will supplement and
not supplant existing funds for
testing
• Individuals who test positive are
referred for and linked to health
care and supportive services
• Health education and literacy
training is provided that enables
clients to navigate the HIV
system
• EIS is provided at or in
coordination with documented
key points of entry
• EIS services are coordinated
with HIV prevention efforts and
programs
Include RFP, contract,
MOU/LOA and/or
statement of work
language that:
• Specifies that Part A
funding is to be used
to supplement and
not supplant existing
federal, state, or
local funding for HIV
testing
• Provides EIS
definitions and
description of EIS
service delivery
models (funded
through Ryan White)
that include and are
limited to counseling
and HIV testing,
referral to
appropriate services
based on HIV status,
linkage to care, and
education and health
literacy training for
clients to help them
navigate the HIV
care system
• Specifies that
services shall be
provided at specific
points of entry
• Establish memoranda
of understanding
(MOUs) with key points
of entry into care to
facilitate access to care
for those who test
positive
• Document provision of
all four required EIS
service components,
with Part A or other
funding
• Document and report
on numbers of HIV
tests and positives, as
well as where and
when Part A-funded
HIV testing occurs
• Document that HIV
testing activities and
methods meet CDC
and state requirements
• Document the number
of referrals for health
care and supportive
services
• Document referrals
from key points of entry
to EIS programs
• Document training and
education sessions
designed to help
individuals navigate
Source
Citation
PHS ACT
2604 (e)
Additional
policy guidance
forthcoming,
including
expectations
for Health
education and
literacy
training, which
are not
covered in the
legislation
10
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
5. Provision of Health
Insurance Premium and
Cost-sharing Assistance
that provides a cost-effective
alternative to ADAP by:
• Purchasing health insurance
that provides comprehensive
primary care and pharmacy
benefits for low income
clients that provide a full
range of HIV medications
• Paying co-pays (including copays for prescription eyewear
for conditions related to HIV
infection) and deductibles on
Performance Measure/
Method
• Documentation of an annual
cost-benefit analysis illustrating
the greater benefit in
purchasing public or private
health insurance, pharmacy
benefits, co-pays and or
deductibles for eligible low
income clients, compared to the
costs of having the client in the
Ryan White Services Program
• Where funds are covering
premiums, documentation that
the insurance plan purchased
provides comprehensive
primary care and a full range of
Grantee
Responsibility
Provider/Subgrantee
Responsibility
• Specifies required
coordination with
HIV prevention
efforts and programs
• Requires
coordination with
providers of
prevention services
• Requires monitoring
and reporting on the
number of HIV tests
conducted and the
number of positives
found
• Requires monitoring
of referrals into care
and treatment
and understand the
HIV system of care
• Establish linkage
agreements with
testing sites where Part
A is not funding testing
but is funding referral
and access to care,
education and system
navigation services
• Obtain written approval
from the grantee to
provide EIS services in
points of entry not
included in original
scope of work
Include RFP, contract,
MOU/LOA and/or
statement of work
language that:
• Conduct an annual
cost benefit analysis (if
not done by the
grantee) that
addresses noted
criteria
• Where premiums are
covered by Ryan White
funds, provide proof
that the insurance
policy provides
comprehensive primary
care and a formulary
with a full range of HIV
medications
• Specify that Part A
funding is to be used
to supplement and
not supplant existing
federal, state, or
local funding for
Health Insurance
Premium and costsharing assistance
• Ensure an annual
Source
Citation
PHS ACT
2604 (c)(3)(F)
HAB Policy
Notice 10-02
11
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
behalf of the client
• Providing funds to contribute
to a client’s Medicare Part D
true out-of-pocked (TrOOP)
costs 2
2
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
HIV medications
• Where funds are used to cover
co-pays for prescription
eyewear, documentation
including a physician’s written
statement that the eye condition
is related to HIV infection
• Assurance that any cost
associated with liability risk
pools is not being funded by
Ryan White
• Assurance that Ryan White
funds are not being used to
cover costs associated with
Social Security
• Documentation of clients’ low
income status as defined by the
EMA/TGA
cost benefit analysis
that demonstrates
the greater benefit of
using Ryan White
funds for
Insurance/CostsSharing Program
versus having the
client on ADAP
• Monitor provider
documentation of
client eligibility
determination
• Where funds are
used to cover the
costs associated
with insurance
premiums, ensure
that comprehensive
primary care
services and a full
range of HIV
medications are
available to clients
• Ensure RFP,
contracts,
MOU/LOA, and/or
statements of work
contain clear
directives on the
• Maintain proof of lowincome status,
• Provide documentation
that demonstrates that
funds were not used to
cover costs of liability
risk pools, or social
security
• Coordinate with CMS,
including entering into
appropriate
agreements, to ensure
that funds are
appropriately included
in TrOOP or donut hole
costs
• When funds are used
to cover co-pays for
prescription eyewear,
provide a physician’s
written statement that
the eye condition is
related to HIV infection
Source
Citation
Allowable use of Ryan White funds as of January 1, 2011 as specified in the Affordable Care Act.
12
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
payment of
premiums, co-pays
(including co-pays
for prescription
eyewear for
conditions related to
HIV infection) and
deductibles
• Monitoring systems
to check that funds
are NOT being used
for liability risk pools,
or social security
• Ensure coordination
with CMS, including
entering into
appropriate
agreements, to
ensure that funds
are appropriately
included in and or
Medicare -TrOOP or
client out of pocket
costs
6. Support for Home Health
Care services provided in the
patient’s home by licensed
health care workers such as
nurses; services to exclude
personal care and to include:
• The administration of
intravenous and aerosolized
Assurance that:
• Services are limited to medical
therapies in the home and
exclude personal care services
• Services are provided by home
health care workers with
appropriate licensure as
required by State and local laws
• Include in the RFP,
contract, MOU/LOA
and/or statement of
work a clear
definition of services
to be provided and
staffing and
licensure
PHS ACT
• Document the number
and types of services in 2604 (c)(3)(G)
the client records, with
the provider’s signature
included
• Maintain on file and
provide to the grantee
on request copies of
13
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
treatment
• Parenteral feeding
• Diagnostic testing
• Other medical therapies
7. Provision of Home and
Community-based Health
Services, defined as skilled
health services furnished in
the home of an HIV-infected
individual, based on a written
plan of care prepared by a
case management team that
includes appropriate health
care professionals
Allowable services include:
• Durable medical equipment
• Home health aide and
personal care services
• Day treatment or other partial
hospitalization services
• Home intravenous and
aerosolized drug therapy
(including prescription drugs
administered as part of such
therapy)
• Routine diagnostic testing
• Documentation that:
o All services are provided
based on a written care plan
signed by a case manager
and a clinical health care
professional responsible for
the individual’s HIV care and
indicating the need for these
services
o The care plan specifies the
types of services needed and
the quantity and duration of
services
o All planned services are
allowable within the service
category
• Documentation of services
provided that:
o Specifies the types, dates,
and location of services
o Includes the signature of the
professional who provided
the service at each visit
Grantee
Responsibility
Provider/Subgrantee
Responsibility
requirements
the licenses of home
health care workers
• Review client
records to determine
compliance with
contract conditions
and Ryan White
program
requirements
• Review licenses and
certificates
• Include RFP,
• Ensure that written
contract, MOU/LOA
care plans with
and/or statement of
appropriate content
work language that
and signatures are
specifies what
consistently prepared,
services are
included in client
allowable, the
records, and updated
requirement that
as needed
they be provided in
• Establish and maintain
the home of a client
a program and client
with HIV/AIDS, and
record keeping system
the requirement for a
to document the types
written care plan
of home services
signed by a case
provided, dates
manager and a
provided, the location
skilled health care
of the service, and the
professional
signature of the
responsible for the
professional who
individual’s HIV care
provided the service at
each visit
• Review program files
and client records to • Make available to the
ensure that
grantee program files
treatment plans are
and client records as
Source
Citation
PHS ACT
2604 (c)(3)(J)
PHS ACT
2614(a)(1-3)
14
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
• Appropriate mental health,
developmental, and
rehabilitation services
Non-allowable services include:
• Inpatient hospital services
• Nursing home and other long
term care facilities
Performance Measure/
Method
o Indicates that all services are
allowable under this service
category
o Provides assurance that the
services are provided in
accordance with allowable
modalities and locations
under the definition of home
and community based health
services
• Documentation of appropriate
licensure and certifications for
individuals providing the
services, as required by local
and state laws
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
prepared for all client
required for monitoring
and that they
• Provide assurance that
include:
the services are being
o Need for home
provided only in an
and communityHIV-positive client’s
based health
home
services
• Maintain, and make
o Types, quantity
available to the grantee
and length of time
on request, copies of
services are to be
appropriate licenses
provided
and certifications for
• Review client
professionals providing
records to
services
determine:
o Services
provided, dates,
and locations
o Whether services
provided were
allowable
o Whether they
were consistent
with the treatment
plan
o Whether the file
includes the
signature of the
professional who
provided the
service
o Require
assurance that
the services are
15
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
•
8. Provision of Hospice Care
provided by licensed hospice
care providers to clients in
the terminal stages of illness,
in a home or other residential
setting, including a nonacute-care section of a
hospital that has been
designated and staffed to
provide hospice care for
terminal patients
Allowable services:
• Room
• Board
• Nursing care
• Mental health counseling
• Physician services
• Palliative therapeutics
• Documentation including the
following:
o Physician certification that
the patient’s illness is
terminal as defined under
Medicaid hospice
regulations (having a life
expectancy of 6 months or
less)
o Appropriate and valid
licensure of provider as
required by the State in
which hospice care is
delivered
o Types of services provided,
and assurance that they
include only allowable
services
o Locations where hospice
•
•
•
Provider/Subgrantee
Responsibility
provided in
accordance with
allowable
modalities and
locations under
the definition of
home and
community based
health services
Review licensure
and certifications to
ensure compliance
with local and state
laws
Specify in the RFP,
• Obtain and have
contract, MOU/LOA
available for inspection
and/or statement of
appropriate and valid
work language
licensure to provide
allowable services,
hospice care
service standards,
• Maintain and provide
service locations,
the grantee access to
and licensure
program files and client
requirements
records that include
Review provider
documentation of
licensure to ensure it
o Physician
meets requirements
certification of
of State in which
clients terminal
hospice care is
status
delivered
o Services provided
and that they are
Review program files
allowable under
and client records to
Ryan White and in
ensure the following:
accordance with the
o Physician
Source
Citation
PHS ACT
2604 (c)(3)(I)
HAB Policy
Notice 10-02
16
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Funding of Mental Health
Services that include
psychological and psychiatric
treatment and counseling
services offered to individuals
with a diagnosed mental
illness, conducted in a group
Performance Measure/
Method
services are provided, and
assurance that they are
limited to a home or other
residential setting or a nonacute care section of a
hospital designated and
staffed as a hospice setting
• Assurance that services meet
Medicaid or other applicable
requirements, including the
following:
o Counseling services that are
consistent with the definition
of mental health counseling,
including treatment and
counseling provided by
mental health professionals
(psychiatrists, psychologists,
or licensed clinical social
workers) who are licensed or
authorized within the State
where the service is provided
o Palliative therapies that are
consistent with those covered
under the respective State’s
Medicaid program
• Documentation of appropriate
and valid licensure and
certification of mental health
professionals as required by the
State
• Documentation of the existence
of a detailed treatment plan for
Grantee
Responsibility
Provider/Subgrantee
Responsibility
certification of
client’s terminal
status
o Documentation
that services
provided are
allowable and
funded hospice
activities
o Assurance that
hospice services
are provided in
permitted settings
o Assurance that
services such as
counseling and
palliative
therapies meet
Medicaid or other
applicable
requirements
provider contract
and scope of work
o Locations where
hospice services are
provided include
only permitted
settings
o Services such as
counseling and
palliative therapies
meet Medicaid or
other applicable
requirements as
specified in the
contract
• Specify in the RFP,
contract, MOU/LOA
and/or statement of
work language what
are allowable
services and
treatment modalities,
• Obtain and have on file
and available for
grantee review
appropriate and valid
licensure and
certification of mental
health professionals
Source
Citation
PHS ACT
2604 (c)(3)(K)
17
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
or individual setting, based
on a detailed treatment plan,
and provided by a mental
health professional licensed
or authorized within the State
to provide such services,
typically including
psychiatrists, psychologists,
and licensed clinical social
workers
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
each eligible client that includes:
o The diagnosed mental illness
or condition
o The treatment modality
(group or individual)
o Start date for mental health
services
o Recommended number of
sessions
o Date for reassessment
o Projected treatment end
date,
o Any recommendations for
follow up
o The signature of the mental
health professional rendering
service
• Documentation of service
provided to ensure that:
o Services provided are
allowable under Ryan White
guidelines and contract
requirements
o Services provided are
consistent with the treatment
plan
staffing and
licensure
requirements, and
requirements for
treatment plans and
service
documentation
• Review staffing and
the licenses and
certification of
mental health
professionals to
ensure compliance
with Ryan White and
State requirements
• Review program
reports and client
records to:
o Ensure the
existence of a
treatment plan
that includes
required
components and
signature
o Document
services
provided, dates,
and their
compliance with
Ryan White
requirements and
with the treatment
• Maintain client records
that include:
o A detailed treatment
plan for each
eligible client that
includes required
components and
signature
o Documentation of
services provided,
dates, and
consistency with
Ryan White
requirements and
with individual client
treatment plans
Source
Citation
18
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
plan
9. Support for Medical
Nutrition Therapy services
including nutritional
supplements provided
outside of a primary care visit
by a licensed registered
dietician; may include food
provided pursuant to a
physician’s recommendation
and based on a nutritional
plan developed by a licensed
registered dietician
Documentation of:
• Licensure and registration of the
dietician as required by the
State in which the service is
provided
• Where food is provided to a
client under this service
category, a client record is
maintained that includes a
physician’s recommendation
and a nutritional plan
• Required content of the
nutritional plan, including:
o Recommended services and
course of medical nutrition
therapy to be provided,
including types and amounts
of nutritional supplements
and food
o Date service is to be initiated
o Planned number and
frequency of sessions
o The signature of the
registered dietician who
developed the plan
• Services provided, including:
o Nutritional supplements and
food provided, quantity, and
dates
o The signature of each
registered dietician who
• Specify in the RFP,
• Maintain and make
contract, MOU/LOA
available to the grantee
and/or statement of
copies of the dietician’s
work language that
license and registration
indicates: :
• Document services
o The allowable
provided, number of
services to be
clients served, and
provided
quantity of nutritional
o The requirement
supplements and food
for provision of
provided to clients
services by a
• Document in each
licensed
client record:
registered
o Services provided
dietician
and dates
o The requirement
o Nutritional plan as
for a nutritional
required, including
plan and
required information
physician’s
and signature
recommendation
o Physician’s
where food is
recommendation for
provided through
the provision of food
this service
category
o The required
content of the
nutritional plan
• Review program files
and client records
for:
o Documentation of
the licensure and
PHS ACT
2604 (c)(3)(H)
HAB Policy
Notice 10-02
19
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
rendered service, the date of
service
o Date of reassessment
o Termination date of medical
nutrition therapy
o Any recommendations for
follow up
Grantee
Responsibility
o
o
o
o
Provider/Subgrantee
Responsibility
Source
Citation
registration of the
dietician providing
services
Documentation of
services
provided,
including the
quantity and
number of
recipients of
nutritional
supplements and
food
Documentation of
physician
recommendations
and nutritional
plans for clients
provided food
Content of the
nutritional plan
Documentation of
medical
nutritional therapy
services provided
to each client,
compliance with
Ryan White and
contract
requirements,
and consistency
of services with
the nutritional
20
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• Provide written
assurances and
maintain
documentation
showing that medical
case management
services are provided
by trained
professionals who are
either medically
credentialed or trained
health care staff and
operate as part of the
clinical care team
• Maintain client records
that include the
required elements for
compliance with
contractual and Ryan
White programmatic
requirements, including
required case
management activities
such as services and
activities, the type of
contact, and the
duration and frequency
of the encounter
PHS ACT
2604 (c)(3)(M)
plan
10. Support for Medical Case
Management Services
(including treatment
adherence) to ensure timely
and coordinated access to
medically appropriate levels
of health and support
services and continuity of
care, provided by trained
professionals, including both
medically credentialed and
other health care staff who
are part of the clinical care
team, through all types of
encounters including face-toface, phone contact, and any
other form of communication
Activities that include at least the
following:
• Initial assessment of service
needs
• Development of a
comprehensive,
individualized care plan
• Coordination of services
required to implement the
plan
• Continuous client monitoring
to assess the efficacy of the
plan
• Documentation that service
providers are trained
professionals, either medically
credentialed persons or other
health care staff who are part of
the clinical care team
• Documentation that the
following activities are being
carried out for clients as
necessary:
o Initial assessment of service
needs
o Development of a
comprehensive,
individualized care plan
o Coordination of services
required to implement the
plan
o Continuous client monitoring
to assess the efficacy of the
plan
o Periodic re-evaluation and
adaptation of the plan at least
every 6 months, during the
enrollment of the client
• Documentation in program and
client records of case
management services and
encounters, including:
o Types of services provided
o Types of encounters/
• Develop RFPs and
contracts that:
o Clearly define
medical case
management
services and
activities and
specify required
activities and
components
o Specify required
documentation to
be included in
client records
• Review client
records and service
documentation to
ensure compliance
with contractual and
Ryan White
programmatic
requirements,
including inclusion of
required case
management
activities
• Review medical
credentials and/or
evidence of training
of health care staff
providing medical
HAB Policy
Notice 10-02
21
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
• Periodic re-evaluation and
adaptation of the plan at least
every 6 months, as
necessary
o Duration and frequency of
Service components that may
include:
• A range of client-centered
services that link clients with
health care, psychosocial,
and other services, including
benefits/ entitlement
counseling and referral
activities assisting them to
access other public and
private programs for which
they may be eligible (e.g.,
Medicaid, Medicare Part D,
State Pharmacy Assistance
Programs, Pharmaceutical
Manufacturers’ Patient
Assistance Programs, and
other State or local health
care and supportive services)
• Coordination and follow up of
medical treatments
• Ongoing assessment of the
client’s and other key family
members’ needs and
personal support systems
• Treatment adherence
counseling to ensure
readiness for, and adherence
communication
the encounters
• Documentation in client records
of services provided, such as:
o Client-centered services that
link clients with health care,
psychosocial, and other
services and assist them to
access other public and
private programs for which
they may be eligible
o Coordination and follow up of
medical treatments
o Ongoing assessment of
client’s and other key family
members’ needs and
personal support systems
o Treatment adherence
counseling
o Client-specific advocacy
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
case management
services
• Obtain assurances
and documentation
showing that medical
case management
staff are operating
as part of the clinical
care team
22
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
to, complex HIV/AIDS
treatments
• Client-specific advocacy
and/or review of utilization of
services
11. Support for Substance
Abuse Treatment ServicesOutpatient, provided by or
under the supervision of a
physician or other
qualified/licensed personnel;
may include use of funds to
expand HIV-specific capacity
of programs if timely access
to treatment and counseling
is not otherwise available
Services limited to the following:
• Pre-treatment/recovery
readiness programs
• Harm reduction
• Mental health counseling to
reduce depression, anxiety
and other disorders
associated with substance
abuse
• Outpatient drug-free
treatment and counseling
• Opiate Assisted Therapy
• Neuro-psychiatric
pharmaceuticals
• Relapse prevention
• Limited acupuncture services
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• Documentation that services
are provided by or under the
supervision of a physician or by
other qualified personnel with
appropriate and valid licensure
and certification as required by
the State in which services are
provided
• Documentation through
program files and client records
that:
o Services provided meet the
service category definition
o All services provided with
Part A funds are allowable
under Ryan White
• Assurance that services are
provided only in an outpatient
setting
• Assurance that Ryan White
funds are used to expand HIVspecific capacity of programs
only if timely access would not
otherwise be available to
treatment and counseling
• Assurance that services
provided include a treatment
plan that calls for only allowable
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that clearly specify:
o Allowable
activities under
this service
category
o The requirement
that services be
provided on an
outpatient basis
o The information
that must be
documented in
each client’s file
• Review staff
licensure and
certification and
staffing structure to
ensure that services
are provided under
the supervision of a
physician or other
qualified/licensed
personnel
• Require assurance
• Maintain and provide to
grantee on request
documentation of:
o Provider licensure
or certifications as
required by the
State in which
service is provided;
this includes
licensures and
certifications for a
provider of
acupuncture
services
o Staffing structure
showing supervision
by a physician or
other qualified
personnel
• Provide assurance that
all services are
provided on an
outpatient basis
• Maintain program files
and client records that
include treatment plans
with all required
elements and
PHS ACT
2604 (c)(3)(L)
HAB Policy
Notice 10-02
23
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
with a written referral from the
client’s primary health care
provider, provided by certified
or licensed practitioners
wherever State certification or
licensure exists
• Services provided must
include a treatment plan that
calls only for allowable
activities and includes:
o The quantity, frequency,
and modality of treatment
provided
o The date treatment begins
and ends
o Regular monitoring and
assessment of client
progress
o The signature of the
individual providing the
service and or the
supervisor as applicable
Performance Measure/
Method
activities and includes:
o The quantity, frequency, and
modality of treatment
provided
o The date treatment begins
and ends
o Regular monitoring and
assessment of client
progress
o The signature of the
individual providing the
service and or the supervisor
as applicable
• Documentation that
o The use of funds for
acupuncture services is
limited through some form of
defined cap
o Acupuncture is not the
dominant treatment modality
o Acupuncture services are
provided only with a written
referral from the client’s
primary care provider
o The acupuncture provider
has appropriate State
license and certification
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
that services are
document:
provided on an
o That all services
outpatient basis
provided are
allowable under
• Review program files
Ryan White
and client records for
o The quantity,
evidence of a
frequency and
treatment plan that
modality of
specifies only
treatment services
allowable activities
o The date treatment
and includes:
begins, and ends
o The quantity,
o Regular monitoring
frequency, and
and assessment of
modality of
client progress
treatment
o The signature of the
provided
individual providing
o The date
the service or the
treatment begins
supervisor as
and ends
applicable
o Regular
monitoring and
• In cases where
assessment of
acupuncture therapy
client progress
services are provided,
o The signature of
document in the client
the individual
file:
providing the
o A written referral
service and or the
from the primary
supervisor as
health care provider
applicable
o The quantity of
acupuncture
• For any client
services provided
receiving
o The cap on such
acupuncture
services
services under this
service category,
24
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
documentation in the
client file including:
o Caps on use of
Ryan White funds
are in place
o A written referral
from their primary
health care
provider
o Proof that the
acupuncturist has
appropriate
certification or
licensure, if the
State provides
such certification
or licensure
Section C: Support
Services
1. Use of Part A funds only for
Support Services approved
by the Secretary of Health
and Human Services
Documentation that all funded
support services are on the current
list of HHS-approved support
services
2. Support for Case
Management (Non-medical)
services that provide advice
and assistance to clients in
Documentation that:
• Scope of activity includes
advice and assistance to
clients in obtaining medical,
• Provide and contract
for only HHSapproved support
services
• Monitor subgrantees
to ensure that no
Part A funds are
used for nonallowable services
categories
Include in RFPs,
contracts, MOU/LOA,
and/or statements of
work:
• Provide assurance to
the grantee that Part A
funds are being used
only for support
services approved by
HHS
PHS ACT
2604 (d)
Maintain client records
that include the required
elements as detailed by
the grantee, including:
Dr. ParhamHopson Letter
8/14/09
25
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
obtaining medical, social,
community, legal, financial,
and other needed services
May include:
• Benefits/entitlement
counseling and referral
activities to assist eligible
clients to obtain access to
public and private programs
for which they may be eligible
• All types of case management
encounters and
communications (face-toface, telephone contact, other)
• Transitional case
management for incarcerated
persons as they prepare to
exit the correctional system
Note: Does not involve
coordination and follow up of
medical treatments
Performance Measure/
Method
social, community, legal,
financial, and other needed
services
• Where benefits/ entitlement
counseling and referral
services are provided, they
assist clients in obtaining
access to both public and
private programs, such as
Medicaid, Medicare Part D,
State Pharmacy Assistance
Programs, Pharmaceutical
Manufacturers’ Patient
Assistance Programs, and
other State or local health
care and supportive services
• Services cover all types of
encounters and
communications (e.g., faceto-face, telephone contact,
other)
Where transitional case
management for incarcerated
persons is provided, assurance
that such services are provided
either as part of discharge planning
or for individuals who are in the
correctional system for a brief
period
Grantee
Responsibility
Provider/Subgrantee
Responsibility
• Clear statement
of required and
optional case
management
services and
activities,
including benefits/
entitlement
counseling,
• Full range of
allowable types of
encounters and
communications
• Require in contract
that client records
document at least
the following:
o Date of each
encounter
o Type of
encounter (e.g.,
face-to-face,
telephone
contact, etc.)
o Duration of
encounter
o Key activities
• Review client
records and service
documentation for
compliance with
contract
requirements
• Date of encounter
• Type of encounter
• Duration of
encounter
• Key activities,
including benefits/
entitlement
counseling and
referral services
Source
Citation
HAB Policy
Notice 10-02
Provide assurances that
any transitional case
management for
incarcerated persons
meets contract
requirements
26
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
3.
Funding for Child Care
Services for the children of
HIV-positive clients, provided
intermittently, only while the
client attends medical or
other appointments or Ryan
White HIV/AIDS Programrelated meetings, groups, or
training sessions
May include use of funds to
support:
• A licensed or registered child
care provider to deliver
intermittent care
• Informal child care provided
by a neighbor, family
member, or other person
(with the understanding that
existing Federal restrictions
prohibit giving cash to clients
or primary caregivers to pay
for these services)
Such allocations to be limited
and carefully monitored to
assure:
• Compliance with the
prohibition on direct payments
to eligible individuals
• Assurance that liability issues
for the funding source are
carefully weighed and
Performance Measure/
Method
Documentation of:
o The parent’s eligibility as
defined by the grantee,
including proof of HIV status
o The medical or other
appointments or Ryan White
HIV/AIDS Program-related
meetings, groups, or training
sessions attended by the
parent that made child care
services necessary
o Appropriate and valid
licensure and registration of
child care providers under
applicable State and local
laws in cases where the
services are provided in a
day care or child care setting
• Assurance that
o Where child care is provided
by a neighbor, family
member, or other person,
payments do not include
cash payments to clients or
primary caregivers for these
services
o Liability issues for the funding
source are addressed
through use of liability
release forms designed to
protect the client, provider,
and the Ryan White Program
o Any recreational and social
Grantee
Responsibility
Provider/Subgrantee
Responsibility
• Develop RFPs,
• Maintain
contracts and
documentation of:
scopes of work as
o Date and duration of
appropriate that
each unit of child
clearly define child
care service
care services and
provided
allowable settings
o Determination of
client eligibility
• Provide
o Reason why child
documentation that
care was needed –
demonstrates that
e.g., client medical
the grantee has
or other
clearly addressed
appointment or
the limitations of
participation in a
informal child care
Ryan White-related
arrangements,
meeting, group, or
including the issues
training session
of liability raised by
o Any recreational
such informal
and social activities,
arrangements in
including
child care and the
documentation that
appropriate and
they were provided
legal releases from
only within a
liability that cover the
certified or licensed
Ryan White Program
provider setting
and other federal,
• Where provider is a
state and local
child care center or
entities as allowed
program, make
by law
available for inspection
• Require provider
appropriate and valid
documentation that
licensure or registration
records the
as required under
frequency, dates,
applicable State and
and length of
Source
Citation
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
8/14/09
HAB Policy
Notice 10-02
27
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
addressed through the use of
liability release forms
designed to protect the client,
provider, and the Ryan White
Program
Performance Measure/
Method
activities are provided only in
a licensed or certified
provider setting
May include Recreational and
Social Activities for the child, if
provided in a licensed or certified
provider setting including drop-in
centers in primary care or
satellite facilities
• Excludes use of funds for offpremise social/recreational
activities or gym membership
Grantee
Responsibility
Provider/Subgrantee
Responsibility
service, and type of
medical or other
appointment or Ryan
White-related
meetings, group, or
training session that
made child care
necessary
• Review provider
documentation to
ensure that child
care is intermittent
and is provided only
to permit the client to
keep medical and
other appointments
or other permitted
Ryan White-related
activities
• Develop a
mechanism for use
with informal child
care arrangements
to ensure that no
direct cash
payments are made
to clients or primary
caregivers
• Document that any
recreational and
social activities are
provided only within
a licensed or
local laws
• Where the provider
manages informal child
care arrangements,
maintain and have
available for grantee
review:
o Documentation of
compliance with
grantee-required
mechanism for
handling payments
for informal child
care arrangements
o Appropriate liability
release forms
obtained that protect
the client, provider,
and the Ryan White
program
o Documentation that
no cash payments
are being made to
clients or primary
care givers
o Documentation that
payment is for
actual costs of
service
Source
Citation
28
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• Maintain client records
that document for each
client:
o Client eligibility and
need for EFA
o Types of EFA
provided
o Date(s) EFA was
provided
o Method of providing
EFA
• Maintain and make
available to the grantee
program
documentation of
assistance provided,
including:
o Number of clients
and amount
expended for each
type of EFA
o Summary of number
of EFA services
received by client
o Methods used to
provide EFA (e.g.,
payments to
agencies, vouchers)
• Provide assurance to
the grantee that all
Funding
Opportunity
Announcement
certified provider
setting
4.
•
•
Support for Emergency
Financial Assistance (EFA)
for essential services
including utilities, housing,
food (including groceries,
food vouchers, and food
stamps), or medications,
provided to clients with
limited frequency and for
limited periods of time,
through either:
Short-term payments to
agencies
Establishment of voucher
programs
Note: Direct cash payments to
clients are not permitted
Documentation of services and
payments to verify that:
• EFA to individual clients is
provided with limited frequency
and for limited periods of time,
with frequency and duration of
assistance specified by the
grantee
• Assistance is provided only for
the following essential services:
utilities, housing, food (including
groceries, food vouchers, and
food stamps), or medications
• Payments are made either
through a voucher program or
short-term payments to the
service entity, with no direct
payments to clients
• Emergency funds are allocated,
tracked, and reported by type of
assistance
• Ryan White is the payer of last
resort
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that:
o Define the
allowable uses of
EFA funds and
the limitations of
the program,
including
number/level of
payments
permitted to a
single client
o Require that
Ryan White funds
are used for EFA
only as a last
resort
o Require providers
to record and
track use of EFA
funds under each
discrete service
category as
required by the
Ryan White
Services Report
(RSR)
Dr. ParhamHopson Letter
8/14/09
DSS Program
Policy
Guidance No.
2, 6/1/2011
HAB Policy
Notice 97-02
HAB Policy
Notice 10-02
29
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
• Review provider
services and
payment
documentation to
assure compliance
with contractual and
Ryan White
programmatic
requirements
including:
o Uses of funds
o Methods of
providing EFA
payments
o Use of Ryan
White as payer of
last resort
o Specified limits
on amounts and
frequency of EFA
to a single client
• Documentation that:
o Services supported are
limited to food bank, homedelivered meals, and/or food
voucher program
o Types of non-food items
provided are allowable
o If water filtration/ purification
systems are provided,
community has water purity
May also include the provision of
issues
non-food items that are limited to:
5. Funding for Food
Bank/Home-delivered
Meals that may include:
• The provision of actual food
items
• Provision of hot meals
• A voucher program to
purchase food
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that specify:
o What types of
services are to be
supported – food
bank, homedelivered meals,
and/or food
Provider/Subgrantee
Responsibility
Source
Citation
EFA:
o Was for allowable
types of assistance
o Was used only in
cases where Ryan
White was the payer
of last resort
o Met granteespecified limitations
on amount and
frequency of
assistance to an
individual client
o Was provided
through allowable
payment methods
• Maintain and make
available to grantee
documentation of:
o Services provided
by type of service,
number of clients
served, and levels
of service
o Amount and use of
funds for purchase
of non-food items,
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
8/14/09
HAB Policy
Notice 10-02
30
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
• Personal hygiene products
• Household cleaning supplies
• Water filtration/ purification
systems in communities
where issues with water purity
exist
Appropriate licensure/
certification for food banks and
home delivered meals where
required under State or local
regulations
No funds used for:
• Permanent water filtration
systems for water entering the
house
• Household appliances
• Pet foods
• Other non-essential products
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
• Assurance of:
o Compliance with federal,
state and local regulations
including any required
licensure or certification for
the provision of food banks
and/or home- delivered
meals
o Use of funds only for
allowable essential non-food
items
• Monitoring of providers to
document actual services
provided, client eligibility,
number of clients served, and
level of services to these clients
voucher program
o Allowable and
prohibited uses of
funds for nonfood items
o Requirements for
documenting
services
provided, client
eligibility, and
level and type of
services provided
to clients
• Monitor providers to
ensure:
o Compliance with
contractual
requirements and
with other federal,
state, and local
laws and
regulations
regarding food
banks, homedelivered meals,
and food voucher
programs,
including any
required licensure
and/or
certifications
o Verification that
Ryan White funds
including use of
funds only for
allowable non-food
items
o Compliance with all
federal, state, and
local laws regarding
the provision of food
bank, homedelivered meals and
food voucher
programs, including
any required
licensure and/or
certifications
• Provide assurance that
Ryan White funds were
used only for allowable
purposes and Ryan
White was the payer of
last resort
Source
Citation
31
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• Maintain, and make
available to the grantee
on request, records of
services provided
• Document in client
records:
o Client eligibility
determination
o Information provided
on available medical
and psychosocial
support services
o Education about
HIV transmission
o Counseling on how
to improve their
health status and
reduce the risk of
HIV transmission
Funding
Opportunity
Announcement
are used only for
purchase of
allowable nonfood items
6. Support for Health
Education/Risk Reduction
services that educate clients
living with HIV about HIV
transmission and how to
reduce the risk of HIV
transmission
Includes:
• Provision of information about
available medical and
psychosocial support services
• Education on HIV
transmission and how to
reduce the risk of
transmission
• Counseling on how to
improve their health status
and reduce the risk of HIV
transmission to others
Documentation that clients served
under this category:
• Are educated about HIV
transmission and how to reduce
the risk of HIV transmission to
others
• Receive information about
available medical and
psychosocial support services
• Receive education on methods
of HIV transmission and how to
reduce the risk of transmission
• Receive counseling on how to
improve their health status and
reduce the risk of transmission
to others
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that define risk
reduction counseling
and provide
guidance on the
types of information,
education, and
counseling to be
provided to the client
• Review provider
data to:
o Determine
compliance with
contract and
program
obligations
o Ensure that
clients have been
educated and
counseled on HIV
transmission and
risk reduction
o Ensure that
clients have been
provided
Dr. ParhamHopson Letter
8/14/09
32
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
7. Support for Housing
Services that involve the
provision of short-term
assistance to support
emergency, temporary or
transitional housing to enable
an individual or family to gain
or maintain medical care
Funds received under the Ryan
White HIV/AIDS Program may be
used for the following housing
expenditures:
• Housing referral services
defined as assessment,
search, placement, and
advocacy services must be
provided by case managers or
other professional(s)who
possess a comprehensive
knowledge of local, state, and
federal housing programs and
how these programs can be
accessed; or
• Short-term or emergency
housing defined as necessary
to gain or maintain access to
medical care and must be
related to either:
- Housing services that include
Performance Measure/
Method
• Documentation that funds are
used only for allowable
purposes:
o The provision of short-term
assistance to support
emergency, temporary, or
transitional housing to enable
an individual or family to gain or
maintain medical care.
Housing-related referral services
including housing assessment,
search, placement, advocacy, and
the fees associated with them.
• Housing related referrals are
provided by case managers or
other professional(s)who
possess a comprehensive
knowledge of local, state, and
federal housing programs and
how to access these programs
For all housing, regardless of
whether or not the service includes
some type of medical or supportive
services.
• Each client receives assistance
designed to help him/her obtain
stable long-term housing,
through a strategy to identify, re-
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
information about
available medical
and psychosocial
support services
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that clearly define
and specify
allowable housingrelated services,
including housingrelated referrals,
types of housing,
and focus on shortterm housing
assistance
• Review and monitor
provider programs
to:
o Determine
compliance with
contract and
program
requirements
o Ensure that
housing referral
services include
housing
assessment,
search,
placement,
• Document:
o Services provided
including number of
clients served,
duration of housing
services, types of
housing provided,
and housing referral
services
• Ensure staff providing
housing services are
case managers or
other professionals
who possess a
comprehensive
knowledge of local,
state, and federal
housing programs and
how to access those
programs.
• Maintain client records
that document:
o Client eligibility
determination
o Housing services,
including referral
services provided
o Individualized
housing plans for all
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
8/14/09
HAB Policy
Notice 11– 01
76 FR 27649
33
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
some type of medical or
supportive service: including, but
not limited to, residential
substance treatment or mental
health services (not including
facilities classified as an
Institution for Mental Diseases
under Medicaid), residential
foster care, and assisted living
residential services; or
- Housing services that do not
provide direct medical or
supportive services, but are
essential for an individual or
family to gain or maintain access
and compliance with HIV-related
medical care and treatment;
necessity of housing services for
purposes of medical care must
be certified or documented.
•
Grantees must develop
mechanisms to allow newly
identified clients access to
housing services.
Performance Measure/
Method
Grantee
Responsibility
locate, and/or ensure the
individual or family is moved to
or capable of maintaining a
stable long-term living situation
advocacy, and
the fees
associated with
them
• Ensure that housing
related referrals are
provided by case
managers or other
professional(s) who
possess a
comprehensive
knowledge of local,
state, and federal
housing programs
and how to access
these programs
• Housing services are essential
for an individual or family to gain
or maintain access and
compliance with HIV-related
medical care and treatment.
• Mechanisms are in place to
allow newly identified clients
access to housing services.
• Policies and procedures to
provide individualized written
housing plan, consistent with
this Housing Policy, covering
each client receiving short term,
transitional and emergency
housing services.
• No funds are used for direct
payments to recipients of
services for rent or mortgages
Upon request, Ryan White
HIV/AIDS Program Grantees
must provide HAB with an
individualized written housing
plan, consistent with this
Housing Policy, covering
Provider/Subgrantee
Responsibility
Source
Citation
clients that receive
short-term,
transitional, and
emergency housing
services
• Mechanisms are in
place to allow newly
identified clients
access to housing
services.
• Develop and maintain
housing policies and
procedures that are
consistent with this
Housing Policy
o Assistance provided
to clients to help
o Ensure that
them obtain stable
clients receive
long-term housing
assistance in
Provide documentation
obtaining stable
and assurance that no
long-term housing
Ryan White funds are
o Ensure that
used to provide direct
housing services
payments to clients for
are essential to
rent or mortgages
maintaining or
accessing HIVrelated medical
care and
treatment
o Ensure that
Mechanisms are
34
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
each client receiving short
term, transitional and
emergency housing services.
•
•
Short-term or emergency
assistance is understood as
transitional in nature and for
the purposes of moving or
maintaining an individual or
family in a long-term, stable
living situation. Thus, such
assistance cannot be
permanent and must be
accompanied by a strategy to
identify, relocate, and/or
ensure the individual or
family is moved to, or
capable of maintaining, a
long-term, stable living
situation.
Housing funds cannot be in
the form of direct cash
payments to recipients or
services and cannot be used
for mortgage payments.
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
in place to allow
newly identified
clients access to
housing services
o Monitor providers
to ensure policies
and procedures
are in place
requiring an
individualized
written housing
plan consistent
with this Housing
Policy, covering
each client
receiving short
term, transitional
and emergency
housing services
o Verify that no
Ryan White funds
are used for
direct payment to
clients for rent or
mortgages
Note: Ryan White HIV/AIDS
Program Grantees and local
decision making planning bodies,
i.e. Part A and Part B, are
strongly encouraged to institute
duration limits to provide
35
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
transitional and emergency
housing services. HUD defines
transitional housing as 24
months and HRSA/HAB
recommends that grantees
consider using HUD’s definition
as their standard
8. Funding for Legal Services
provided for an HIV-infected
person to address legal
matters directly necessitated
by the individual’s HIV status
Such services include(but are not
limited to:
• Preparation of Powers of
Attorney and Living Wills
• Interventions necessary to
ensure access to eligible
benefits, including
discrimination or breach of
confidentiality litigation as it
relates to services eligible for
funding under Ryan White
• Permanency planning for an
individual or family where the
responsible adult is expected
to pre-decease a dependent
(usually a minor child) due to
HIV/AIDS; includes the
provision of social service
counseling or legal counsel
regarding (1) the drafting of
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• Documentation that funds are
used only for allowable legal
services, which involve legal
matters directly necessitated by
an individual’s HIV status, such
as:
o Preparation of Powers of
Attorney and Living Wills
o Services designed to ensure
access to eligible benefits
o Permanency planning
• Assurance that program
activities do not include any
criminal defense or class-action
suits unrelated to access to
services eligible for funding
under the Ryan White HIV/AIDS
Program
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that clearly define
allowable and nonallowable legal
services and state
the requirement that
services must
address legal
matters directly
necessitated by the
individual’s HIV
status
• Monitor providers to
ensure that:
o Funds are being
used only for
allowable
services
o No funds are
being used for
criminal defense
or for class-action
suits unless
• Document, and make
available to the grantee
upon request, services
provided, including
specific types of legal
services provided
• Provide assurance
that:
o Funds are being
used only for legal
services directly
necessitated by an
individual’s HIV
status
o Ryan White serves
as the payer of last
resort
• Document in each
client file:
o Client eligibility
determination
o A description of how
the legal service is
necessitated by the
individual’s HIV
status
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
8/14/09
HAB Policy
Notice 10-02
36
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
wills or delegating powers of
attorney, (2) preparation for
custody options for legal
dependents including standby
guardianship, joint custody or
adoption.
Excludes:
• Criminal defense
• Class-action suits unless
related to access to services
eligible for funding under the
Ryan White HIV/AIDS
Program
9. Support for Linguistic
Services including
interpretation (oral) and
translation (written) services,
provided by qualified
individuals as a component
of HIV service delivery
between the provider and the
client, when such services
are necessary to facilitate
communication between the
provider and client and/or
support delivery of Ryan
White-eligible services
Grantee
Responsibility
related to access
to services
eligible for
funding under the
Ryan White
HIV/AIDS
Program
• Documentation that
o Linguistic services are being
provided as a component of
HIV service delivery between
the provider and the client, to
facilitate communication
between the client and
provider and the delivery of
Ryan White-eligible services
in both group and individual
settings
o Services are provided by
appropriately trained and
qualified individuals holding
appropriate State or local
certification
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that clearly describe:
o The range and
types of linguistic
services to be
provided,
including oral
interpretation and
written translation
as needed to
facilitate
communications
and service
delivery
o Requirements for
training and
Provider/Subgrantee
Responsibility
Source
Citation
o Types of services
provided
o Hours spent in the
provision of such
services
• Document the
provision of linguistic
services, including:
o Number and types
of providers
requesting and
receiving services
o Number of
assignments
o Languages involved
o Types of services
provided – oral
interpretation or
written translation,
and whether
interpretation is for
an individual client
or a group
• Maintain
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
8/14/09
37
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
qualifications
based on
available State
and local
certification
• Monitor providers to
assure that:
o Linguistic
services are
provided based
on documented
provider need in
order for Ryan
White clients to
communicate with
the provider
and/or receive
appropriate
services
o Interpreters and
translators have
appropriate
training and State
or local
certification
10. Funding for Medical
Transportation Services
that enable an eligible
individual to access HIVrelated health and support
services, including services
needed to maintain the client
• Documentation that: medical
transportation services are used
only to enable an eligible
individual to access HIV-related
health and support services
• Documentation that services are
provided through one of the
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that:
o Clearly define
medical
Provider/Subgrantee
Responsibility
Source
Citation
documentation
showing that
interpreters and
translators employed
with Ryan White funds
have appropriate
training and hold
relevant State and/or
local certification
• Maintain program files
that document:
o The level of
services/number of
trips provided
o The reason for each
trip and its relation
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
8/14/09
38
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
in HIV medical care, through
either direct transportation
services or vouchers or
tokens
May be provided through:
• Contracts with providers of
transportation services
• Voucher or token systems
• Use of volunteer drivers
(through programs with
insurance and other liability
issues specifically addressed)
• Purchase or lease of
organizational vehicles for
client transportation programs,
provided the grantee receives
prior approval for the
purchase of a vehicle
Performance Measure/
Method
following methods:
o A contract or some other
local procurement
mechanism with a provider of
transportation services
o A voucher or token system
that allows for tracking the
distribution of the vouchers or
tokens
o A system of mileage
reimbursement that does not
exceed the federal per-mile
reimbursement rates
o A system of volunteer
drivers, where insurance and
other liability issues are
addressed
o Purchase or lease of
organizational vehicles for
client transportation, with
prior approval from
HRSA/HAB for the purchase
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
transportation in
terms of
allowable
services and
methods of
delivery
o Require record
keeping that
tracks both
services provided
and the purpose
of the service
(e.g.,
transportation
to/from what type
of medical or
support service
appointment)
o Specify
requirements
related to each
service delivery
method
o Require that
clients receive
vouchers or
tokens rather
than direct
payments for
transportation
services
• Monitor providers to
ensure that use of
to accessing health
and support
services
o Trip origin and
destination
o Client eligibility
determination
o The cost per trip
o The method used to
meet the
transportation need
• Maintain
documentation
showing that the
provider is meeting
stated contract
requirements with
regard to methods of
providing
transportation:
o Reimbursement
methods do not
involve cash
payments to
service recipients
o Mileage
reimbursement
does not exceed
the federal
reimbursement rate
o Use of volunteer
drivers
appropriately
HAB Policy
Notice 10-02
39
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
funds meets contract
and program
requirements
• Submit a prior
approval request
when the grantee or
a provider is
proposing the
purchase or lease of
a vehicle(s)
11. Support for Outreach
Services designed to identify
individuals who do not know
their HIV status and/or
individuals who know their
status and are not in care
and help them to learn their
status and enter care
Outreach programs must be:
• Planned and delivered in
coordination with local HIV
prevention outreach programs
to avoid duplication of effort
• Targeted to populations
• Documentation that outreach
services are designed to
identify:
o Individuals who do not know
their HIV status and refer
them for counseling and
testing
o Individuals who know their
status and are not in care
and help them enter or reenter HIV-related medical
care
• Documentation that outreach
services:
o Are planned and delivered in
addresses
insurance and other
liability issues
• Collection and
maintenance of data
documenting that
funds are used only for
transportation
designed to help
eligible individuals
remain in medical care
by enabling them to
access medical and
support services
• Obtain grantee
approval prior to
purchasing or leasing
a vehicle(s)
• Develop RFPs and
• Document and be
contracts that:
prepared to share with
the grantee:
o Provide a detailed
description of the
o The design,
required scope
implementation,
and components
target areas and
of an outreach
populations, and
program,
outcomes of
including whether
outreach activities,
it targets
including the
individuals who
number of
know and/or who
individuals reached,
do not know their
referred for testing,
HIV status
found to be positive,
o Specify
referred to care, and
Source
Citation
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
8/14/09
HAB Policy
Notice 07-06
40
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
known through local
epidemiologic data to be at
disproportionate risk for HIV
infection
• Targeted to communities or
local establishments that are
frequented by individuals
exhibiting high-risk behavior
• Conducted at times and in
places where there is a high
probability that individuals with
HIV infection will be reached
• Designed to provide quantified
program reporting of activities
and results to accommodate
local evaluation of
effectiveness
Note: Funds may not be used to
pay for HIV counseling or testing
Performance Measure/
Method
coordination with local HIV
prevention outreach
programs and avoid
duplication of effort
o Target populations known to
be at disproportionate risk for
HIV infection
o Target communities whose
residents have
disproportionate risk or
establishments frequented by
individuals exhibiting highrisk behaviors
o Are designed so that
activities and results can be
quantified for program
reporting and evaluation of
effectiveness
• Documentation and assurance
that outreach funds are not
being used:
o For HIV counseling and
testing
o To support broad-scope
awareness activities that
target the general public
rather than specific
populations and/or
communities with high rates
of HIV infection
o To duplicate HIV prevention
outreach efforts
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
parameters to
entering care
ensure that the
o Data showing that
program meets all
all RFP and contract
HRSA/HAB
requirements are
requirements and
being met with
guidance
regard to program
design, targeting,
o Require clearly
activities, and use of
defined targeting
funds
of populations
and communities • Provide financial and
o Require
program data
quantified
demonstrating that no
reporting of
outreach funds are
individuals
being used:
reached, referred
o To pay for HIV
for testing, found
counseling and
to be positive,
testing
referred to care,
o To support broadand entering
scope awareness
care, to facilitate
activities
evaluation of
o To duplicate HIV
effectiveness
prevention outreach
• Provide program
efforts
monitoring and
review for
compliance with
contract and
program
requirements and to
ensure that funds
are not being used:
o For HIV
counseling and
41
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
12. Support for Psychosocial
Support Services that may
include:
• Support and counseling
activities
• Child abuse and neglect
counseling
• HIV support groups
• Pastoral care/counseling
• Caregiver support
• Bereavement counseling
• Nutrition counseling provided
by a non-registered dietitian
Note: Funds under this service
category may not be used to
provide nutritional supplements
Pastoral care/counseling
supported under this service
category to be:
• Provided by an institutional
pastoral care program (e.g.,
components of AIDS interfaith
networks, separately
incorporated pastoral care
Performance Measure/
Method
• Documentation that
psychosocial services funds are
used only to support eligible
activities, including:
o Support and counseling
activities
o Child abuse and neglect
counseling
o HIV support groups
o Pastoral care/counseling
o Caregiver support
o Bereavement counseling
o Nutrition counseling provided
by a non-registered dietitian
• Documentation that pastoral
care/counseling services meet
all stated requirements:
o Provided by an institutional
pastoral care program
o Provided by a licensed or
accredited provider wherever
such licensure or
accreditation is either
required or available
o Available to all individuals
eligible to receive Ryan
Grantee
Responsibility
Provider/Subgrantee
Responsibility
testing
o To support broadscope awareness
activities
o To duplicate HIV
prevention
outreach efforts
• Develop RFPs,
• Document the
contracts,
provision of
MOU/LOA, and/or
psychosocial support
statements of work
services, including:
that clearly specify:
o Types and level of
activities provided
o The range and
o Client eligibility
limitations of
determination
allowable
services
• Maintain
o Types of
documentation
permitted pastoral
demonstrating that:
care/ counseling
o Funds are used only
• Monitor providers to
for allowable
ensure compliance
services
with contract and
o No funds are used
program
for provision of
requirements
nutritional
supplements
• Provide assurance
o Any pastoral
that:
care/counseling
o Funds are being
services meet all
used only for
stated requirements
allowable
services
o No funds are
being used for the
provision of
Source
Citation
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
8/14/09
HAB Policy
Notice 10-02
42
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
and counseling centers,
components of services
provided by a licensed
provider, such as a home care
or hospice provider)
• Provided by a licensed or
accredited provider wherever
such licensure or accreditation
is either required or available
• Available to all individuals
eligible to receive Ryan White
services, regardless of their
religious denominational
affiliation
White services, regardless of
their religious denominational
affiliation
• Assurance that no funds under
this service category are used
for the provision of nutritional
supplements
13. Support for Referral for
Health Care/Supportive
Services that direct a client
to a service in person or
through telephone, written, or
other types of
communication, including the
management of such
services where they are not
provided as part of
Ambulatory/ Outpatient
Medical Care or Case
Management services
• Documentation that funds are
used only:
o To direct a client to a service
in person or through other
types of communication
o To provide
benefits/entitlements
counseling and referral
consistent with HRSA
requirements
o To manage such activities
o Where these services are not
provided as a part of
Ambulatory/ Outpatient
Medical Care or Case
Management services
• Documentation of:
May include benefits/entitlement
counseling and referrals to assist
eligible clients in obtaining
access to other public and
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• Maintain program files
that document:
o Number and types
of referrals provided
o Benefits counseling
and referral
activities
o Number of clients
served
o Follow up provided
• Maintain client records
that include required
elements as detailed
by the grantee,
including:
o Date of service
o Type of
Funding
Opportunity
Announcement
nutritional
supplements
o Funds for
pastoral
care/counseling
met all stated
requirements
regarding the
program, provider
licensing or
accreditation, and
availability to all
clients regardless
of religious
affiliation
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
to:
o Clearly specify
allowable
activities and
methods of
communication
o Specify that
services may
include benefits/
entitlements
counseling and
referral and
provide a
Dr. ParhamHopson Letter
8/14/09
43
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
private programs for which they
may be eligible, e.g., Medicaid,
Medicare Part D, State
Pharmacy Assistance Programs,
Pharmaceutical Manufacturers’
Patient Assistance Programs,
and other State or local health
care and supportive services
Referrals may be made:
• Within the Non-medical Case
Management system by
professional case managers
• Informally through community
health workers or support
staff
• As part of an outreach
program
Performance Measure/
Method
o Method of client contact/
communication
o Method of providing referrals
(within the non-medical case
management system,
informally, or as part of an
outreach program)
o Referrals and follow up
provided
Grantee
Responsibility
definition and
description of
these services
o Clearly define the
circumstances
under which
these activities
may take place in
order to avoid
duplication with
referrals provided
through other
service
categories such
as Non-medical
Case
Management
o Require
documentation of
referrals and
follow up
• Monitor providers to
ensure compliance
with contract and
program
requirements
• Provide assurance
that funds are not
being used to
duplicate referral
services provided
through other
service categories
Provider/Subgrantee
Responsibility
Source
Citation
communication
o Type of referral
o Benefits
counseling/referral
provided
o Follow up provided
• Maintain
documentation
demonstrating that
services and
circumstances of
referral services meet
contract requirements
44
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
14. Funding for Rehabilitation
Services: Services intended
to improve or maintain a
client’s quality of life and
optimal capacity for self-care,
provided by a licensed or
authorized professional in an
outpatient setting in
accordance with an
individualized plan of care
May include:
• Physical and occupational
therapy
• Speech pathology services
• Low-vision training
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• Documentation that services:
o Are intended to improve or
maintain a client’s quality of
life and optimal capacity for
self-care
o Are limited to allowable
activities, including physical
and occupational therapy,
speech pathology services,
and low-vision training
o Are provided by a licensed or
authorized professional
o Are provided in accordance
with an individualized plan of
care that includes
components specified by the
grantee
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that:
o Clearly define
rehabilitation
services and
allowable
activities
o Specify
requirement for
provision of
services by a
licensed or
authorized
professional in
accordance with
an individualized
plan of care
o Specify where
these activities
may take place in
order to avoid
their provision in
in-patient settings
• Monitor providers to
ensure compliance
with contract and
program
requirements
• Review program and
client records to
• Maintain, and share
with the grantee upon
request, program and
financial records that
document:
o Types of services
provided
o Type of facility
o Provider licensing
o Use of funds only
for allowable
services by
appropriately
licensed and
authorized
professionals
• Maintain client records
that include the
required elements as
detailed by the grantee,
including:
o An individualized
plan of care
o Types of
rehabilitation
services provided
(physical and
occupational
therapy, speech
pathology, lowvision training)
o Dates, duration, and
location of services
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
8/14/09
45
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
15. Support for Respite Care
that includes non-medical
assistance for an HIVinfected client, provided in
community or home-based
settings and designed to
relieve the primary caregiver
responsible for the day-today care of an adult or minor
living with HIV/AIDS
Note: Funds may be used to
support informal respite care
provided issues of liability are
addressed, payment made is
reimbursement for actual costs,
and no cash payments are made
to clients or primary caregivers
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• Documentation that funds are
used only:
o To provide non-medical
assistance for an HIVinfected client to relieve the
primary caregiver responsible
for the day-to-day care of that
adult or minor
o In a community or homebased setting
• If grantee permits use of
informal respite care
arrangements, documentation
that:
o Liability issues have been
addressed
o A mechanism for payments
has been developed that
does not involve direct cash
payment to clients or primary
caregivers
o Payments provide
reimbursement for actual
ensure that:
o Client has an
individualized
plan of care that
includes specified
components
o Services provided
are in accordance
with the plan of
care
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work:
o Clearly define
respite care
including
allowable
recipients,
services, and
settings
o Specify
requirements for
documentation of
dates, frequency,
and settings of
services
• If informal respite
care arrangements
are permitted,
monitor providers to
ensure that:
o Issues of liability
• Maintain, and make
available to the grantee
on request, program
files including:
o Number of clients
served
o Settings/methods of
providing care
• Maintain in each client
file documentation of:
o Client and primary
caretaker eligibility
determination
o Services provided
including dates and
duration
o Setting/method of
services
• Provide program and
financial records and
assurances that if
informal respite care
arrangements are
HAB Policy
Notice 10-02
46
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
costs without over payment,
especially if using vouchers
or gift cards
16. Funding for Substance
Abuse Treatment –
Residential to address
substance abuse problems
(including alcohol and/or
legal and illegal drugs) in a
short-term residential health
service setting
Requirements:
• Services to be provided by or
under the supervision of a
• Documentation that:
o Services are provided by or
under the supervision of a
physician or by other
qualified personnel with
appropriate and valid
licensure and certification as
required by the State in
which services are provided
o Services provided meet the
service category definition
o Services are provided in
Grantee
Responsibility
have been
addressed in a
way that protects
the client,
provider, and
Ryan White
program
o A mechanism is
in place to ensure
that no cash
payments are
made to clients or
primary
caregivers
o Payment made is
for
reimbursement of
actual costs,
especially if using
vouchers or gift
cards
• Develop RFPs,
contracts,
MOU/LOA, and/or
statements of work
that clearly specify:
o Allowable
activities under
this service
category
o The requirement
that services be
provided in a
Provider/Subgrantee
Responsibility
Source
Citation
used:
o Liability issues have
been addressed,
with appropriate
releases obtained
that protect the
client, provider, and
Ryan White
program
o No cash payments
are being made to
clients or primary
caregivers
o Payment is
reimbursement for
actual costs
• Maintain, and provide
to grantee on request,
documentation of:
o Provider licensure
or certifications as
required by the
State in which
service is provided;
this includes
licensures and
certifications for a
provider of
HAB Policy
Notice 10-02
47
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
physician or other qualified
personnel with appropriate
and valid licensure and
certification by the State in
which the services are
provided
• Services to be provided in
accordance with a treatment
plan
• Detoxification to be provided
in a separate licensed
residential setting (including a
separately-licensed
detoxification facility within the
walls of a hospital)
• Limited acupuncture services
permitted with a written
referral from the client’s
primary health care provider,
provided by certified or
licensed practitioners
wherever State certification or
licensure exists
Performance Measure/
Method
Grantee
Responsibility
accordance with a written
treatment plan
• Assurance that services are
provided only in a short-term
residential setting
• Documentation that if provided,
acupuncture services:
o Are limited through some
form of defined financial cap
o Are provided only with a
written referral from the
client’s primary care provider
o Are offered by a provider with
appropriate State license and
certification if it exists
short-term
residential health
service setting
o Limitations and
permitted use of
acupuncture
o Requirements for
a treatment plan
including
specified
elements
o What information
must be
documented in
each client’s file
o What information
is to be reported
to the grantee
• Review staff
licensure and
certification and
staffing structure to
ensure that services
are provided under
the supervision of a
physician or other
qualified/licensed
personnel
• Require assurance
that services are
provided in a shortterm residential
setting
Provider/Subgrantee
Responsibility
•
•
•
•
Source
Citation
acupuncture
services
o Staffing structure
showing supervision
by a physician or
other qualified
personnel
Provide assurance that
all services are
provided in a shortterm residential setting
Maintain program files
that document:
o That all services
provided are
allowable under this
service category
o The quantity,
frequency, and
modality of
treatment services
Maintain client records
that document:
o The date treatment
begins and ends
o Individual treatment
plan
o Evidence of regular
monitoring and
assessment of client
progress
In cases where
acupuncture therapy
48
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
17. Support for Treatment
Adherence Counseling,
which is the provision of
counseling or special
programs to ensure
Performance Measure/
Method
Documentation that services
provided under this category are:
• Designed to ensure readiness
for, and adherence to, complex
HIV/AIDS treatments
Grantee
Responsibility
Provider/Subgrantee
Responsibility
services are provided,
• Monitor provider and
document in the client
review program files
file:
and client records for
o A written referral
evidence of a
from the primary
treatment plan with
health care provider
the required
o The quantity of
components
acupuncture
• For any client
services provided
receiving
acupuncture
services under this
service category,
documentation in the
client file including:
o Caps on use of
Ryan White funds
o A written referral
from their primary
health care
provider
o Proof that the
acupuncturist has
appropriate
certification or
licensure, if the
State provides
such certification
or licensure
• Develop RFPs,
• Provide assurances
contracts,
and maintain
MOU/LOA, and/or
documentation that :
statements of work
o Services provided
that clearly specify:
are limited to those
Source
Citation
Funding
Opportunity
Announcement
Dr. ParhamHopson Letter
49
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
readiness for, and adherence
to, complex HIV/AIDS
treatments, provided by nonmedical personnel outside of
the Medical Case
Management and clinical
setting
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• Provided by non-medical
personnel
• Provided outside of the Medical
Case Management and clinical
setting
o Allowable
activities under
this service
category
o The requirement
that services be
provided by nonmedical
personnel
o The requirement
that services be
provided outside
of the Medical
Case
Management and
clinical setting
o The information
that must be
documented in
each client’s file
and reported to
the grantee
• Monitor provider and
review client records
to ensure
compliance with
contractual and
program
requirements
permitted by the
contract
o Services are
provided by nonmedical personnel
o Services are
provided outside the
Medical Care
Management and
clinical setting
• Maintain client records
that include the
required elements as
detailed by the grantee
8/14/09
• Documentation that the
EMA/TGA has in place a Clinical
• Develop, implement,
and monitor an
• Participate in quality
management activities
PHS ACT 2604
(h)(5)
Section D:
Quality Management
1. Implementation of a Clinical
Quality Management (CQM)
50
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Program to:
• Assess the extent to which
HIV health services provided
to patients under the grant are
consistent with the most
recent HHS Guidelines for the
treatment of HIV/AIDS and
related opportunistic infections
• Develop strategies for
ensuring that services are
consistent with the guidelines
for improvement in the access
to and quality of HIV health
services
CQM program to include:
• A Quality Management Plan
• Quality expectations for
providers and services
• A method to report and track
expected outcomes
• Monitoring of provider
compliance with HHS
Guidelines and the
EMA/TGA’s approved
Standards of Care
Performance Measure/
Method
Grantee
Responsibility
Quality Management Program
that includes, at a minimum:
o A Quality Management Plan
o Quality expectations for
providers and services
o A method to report and track
expected outcomes
o Monitoring of provider
compliance with HHS
Guidelines and the
EMA/TGA’s approved service
category definition for each
funded service
• Review of CQM program to
ensure that both the grantee
and providers are carrying out
necessary CQM activities and
reporting CQM performance
data
EMA/TGA Quality
Management Plan
• Specify in RFPs,
contracts,
MOU/LOA, and/or
statements of work
the grantee’s qualityrelated expectations
for each service
category
• Conduct chart (client
record) reviews and
visits to
providers/subgrantee
s to monitor
compliance with the
Quality Management
Plan, HHS
Guidelines and with
Ryan White Program
quality expectations
• Provide a written
Assurance signed by
the Chief Elected
Official that the
Quality Management
Program meets
HRSA requirements
• Documentation that grantee
administrative costs paid by Part
A funds are not more than 10%
• Document, through
job descriptions and
time and effort
Provider/Subgrantee
Responsibility
Source
Citation
as contractually
required; at a
minimum:
o Compliance with
relevant service
category definitions
and EMA/TGA
standards of care
o Collection and
reporting of data for
use in measuring
performance
Section E:
Administration
1.
Administration: Grantees
are to spend no more than
10% of the total Part A grant
Notice of
Award
51
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
•
•
•
•
•
•
•
•
for routine grant
administration and monitoring
activities, which may include:
Preparation of routine
programmatic and financial
reports
Compliance with grant
conditions and audit
requirements
Activities associated with the
grantee's contract award
procedures including:
o The development of
requests for proposals
(RFPs
o Drafting, negotiation,
awarding, and monitoring
of contract awards
The development of the
applications for Part A funds
The receipt and disbursal of
program funds
The development and
establishment of
reimbursement and
accounting systems
Funding re-allocation
HIV Health Services Planning
Council operations and
support
Performance Measure/
Method
of total grant funds
• Review of activities to ensure
the proper categorization of
allowable administrative
functions
Grantee
Responsibility
reports, that the
activities defined in
the legislation and
guidance as
administration are
charged to
administration of the
program and cost no
more than 10% of
the total grant
amount
• Document that no
activities defined as
administrative in
nature are included
in other Part A
budget categories
• Provide HRSA/HAB
with current
operating budgets
that include sufficient
detail to review
administrative
expenses
Provider/Subgrantee
Responsibility
Source
Citation
PHS ACT 2604
(h)
Part A Manual
Note: Please see Part A Fiscal
Monitoring Standards, especially
52
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
• Documentation that the amount
of Part A funding spent on
services for women, infants,
children, and youth is at least
equal to the proportion each of
these populations represents of
the entire population of persons
living with AIDS in the EMA or
TGA
• If a waiver is requested,
documentation that the service
needs of one or more of these
populations are already met
through funding from another
federal or state program
• Track and report the
amount and
percentage of Part A
funds expended for
each priority
population
separately
• Demonstrate that
expenditures for
each priority
population meet or
exceed the ratio of
reported cases for
that specific
population to the
total AIDS
population
• Apply for a waiver
for one or more of
the designated
populations if
needed care is
provided through
other federal/state
programs
Provider/Subgrantee
Responsibility
Source
Citation
Section A, for additional
information on use of funds for
administration
Section F:
Other Service
Requirements
1.
WICY – Women, Infants,
Children, and Youth:
Amounts set aside for
women, infants, children, and
youth to be determined
based on each of these
population’s relative
percentage of the total
number of persons living with
AIDS in the EMA/TGA
Waiver available if grantee can
document that funds sufficient to
meet the needs of these
population groups are being
provided through other federal or
state programs
Track and report to the
grantee the amount and
percentage of Part A
funds expended for
services to each priority
population
PHS ACT
2604(f)
Dr. Joseph F.
O’Neill Letter
8/10/2000
Doug Morgan
Letter 6/17/03
53
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
2. Referral relationships with
key points of entry:
Requirement that Part A
service providers maintain
appropriate referral
relationships with entities that
constitute key points of entry
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Documentation that written referral
relationships exist between Part A
service providers and key points of
entry
• Require in RFPs,
contracts,
MOU/LOA, and/or
statements of work
that providers
establish written
referral relationships
with defined key
points of entry into
care
• Review
subcontractors’
written referral
agreements with
specified points of
entry
• Review documented
client records to
determine whether
referral relationships
are being used
• Establish written
referral relationships
with specified points of
entry
• Document referrals
from these points of
entry
Key points of entry defined in
legislation:
• Emergency rooms
• Substance abuse and mental
health treatment programs
• Detoxification centers
• Detention facilities
• Clinics regarding sexually
transmitted disease
• Homeless shelters
• HIV disease counseling and
testing sites
Source
Citation
PHS ACT
2605
(a)(1))(C)(3)
Funding
Opportunity
Announcement
Additional points of entry include:
• Public health departments
• Health care points of entry
specified by eligible areas
• Federally Qualified Health
Centers
• Entities such as Ryan White
Part B, C , D, and F grantees
Section G: Prohibitions
on Promotion of Certain
Activities and Additional
54
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
• Include definitions of
unallowable
activities in all
subgrantee RFPs,
contracts,
MOU/LOA, and/or
statements of work,
• Include in financial
monitoring a review
of subgrantee
expenses to identify
any unallowable
costs
• Require subgrantee
budgets and
expense reports with
sufficient budget
justification and
expense detail to
document that they
do not include
unallowable
activities
• Maintain a file with
signed subgrant
agreement,
assurances, and/or
certifications that
specify unallowable
activities
• Ensure that budgets
and expenditures do
not include unallowable
activities
• Ensure that
expenditures do not
include unallowable
activities
• Provide budgets and
financial expense
reports to the grantee
with sufficient detail to
document that they do
not include unallowable
costs or activities
Source
Citation
Requirements
1.
Drug Use and Sexual
Activity: Ryan White funds
cannot be used to support
AIDS programs or materials
designed to promote or
encourage, directly,
intravenous drug use or
sexual activity, whether
homosexual or heterosexual
• Signed contracts, grantee and
subgrantee assurances, and/or
certifications that define and
specifically forbid the use of
Ryan White funds for
unallowable activities
• Grantee review of subgrantee
budget and expenditures to
ensure that they do not include
any unallowable costs or
activities
Notice of
Award
PHS ACT 2684
55
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
2. Purchase of Vehicles
without Approval: No use of
Ryan White funds by
grantees or subgrantees for
the purchase of vehicles
without written approval of
HRSA Grants Management
Officer (GMO)
• Implementation of
measure/method, grantee
responsibility and
provider/subgrantee
responsibility actions specified
in G.1 above
• Where vehicles were
purchased, review of files for
written permission from GMO
• Carry out actions
specified in G.1
above
• If any vehicles were
purchased, maintain
file documentation of
permission of GMO
to purchase a
vehicle
• Carry out subgrantee
actions specified in G.1
above
• If vehicle purchase is
needed, seek grantee
assistance in obtaining
written GMO approval
and maintain document
in file
Notice of
Award
3.
Broad Scope Awareness
Activities: No use of Ryan
White funds for broad scope
awareness activities about
HIV services that target the
general public
• Implementation of actions
specified in G.1 above
• Review of program plans,
budgets, and budget narratives
for marketing, promotions and
advertising efforts, to determine
whether they are appropriately
targeted to geographic areas
and/or disproportionately
affected populations rather than
targeting the general public
• Carry out actions
specified in G.1
above
• Review program
plans and budget
narratives for any
marketing or
advertising activities
to ensure that they
do not include
unallowable
activities
• Carry out subgrantee
actions specified in G.1
above
• Prepare a detailed
program plan and
budget narrative that
describe planned use
of any advertising or
marketing activities
Notice of
Award
Lobbying Activities:
prohibition on the use of
Ryan White funds for
influencing or attempting to
• Implementation of actions
specified in G.1 above
• Review of lobbying certification
and disclosure forms for both
• Carry out actions
specified in G.1
above
• File a signed
• Carry out subgrantee
actions specified in G.1
above
• Include in personnel
* 45 CFR 93
4.
3
HAB Policy
Notice 10-02
HAB Policy
Notice 07-06
3
Notice of
Award
References to the Code of Federal Regulations will be abbreviated as “CFR” throughout this document
56
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
influence members of
Congress and other Federal
personnel
5. Direct Cash Payments: No
use of Ryan White program
funds to make direct
payments of cash to service
recipients
Performance Measure/
Method
Grantee
Responsibility
the grantee and subgrantees
“Certification
Regarding
Lobbying”, and, as
appropriate, a
“Disclosure of
Lobbying Activities”
• Ensure that
subgrantee staff are
familiar and in
compliance with
prohibitions on
lobbying with federal
funds
• Carry out actions
specified in G.1
above
• Ensure that
Standards of Care
for service
categories involving
payments made on
behalf of clients
forbid cash
payments to service
recipients
Note: Forms can be obtained from
the CFR website:
http://www.hhs.gov/forms/PHS5161-1.pdf
http://ecfr.gpoAccess.gov
• Implementation of activities
described in the “Performance
Measure/Method, Grantee
Responsibility and
Provider/Subgrantee
Responsibility” sections in G.1
above
• Review of Standards of Care
and other policies and
procedures for service
categories involving payments
made on behalf of individuals to
ensure that no direct payments
are made to individuals (e.g.,
emergency financial assistance,
transportation, health insurance
premiums, medical or
medication co-pays and
deductibles, food and nutrition)
• Review of expenditures by
Provider/Subgrantee
Responsibility
manual and employee
orientation information
on regulations that
forbid lobbying with
federal funds
• Carry out subgrantee
actions specified in G.1
above
• Maintain
documentation that all
provider staff have
been informed of
policies that forbid use
of Ryan White funds for
cash payments to
service recipients
Source
Citation
Dr. ParhamHopson Letter
2/3/09
PHS ACT
2604(i)
HAB Policy
Notice 10-02
57
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
6. Employment and
Employment-Readiness
Services: prohibition on the
use of Ryan White program
funds to support
employment, vocational, or
employment-readiness
services
7. Maintenance of Privately
Owned Vehicle: No use of
Ryan White funds for direct
maintenance expenses (tires,
repairs, etc.) of a privately
owned vehicle or any other
costs associated with a
vehicle, such as lease or loan
payments, insurance, or
license and registration fees
Note: This restriction does not
apply to vehicles operated by
organizations for program
purposes
Performance Measure/
Method
subgrantees to ensure that no
cash payments were made to
individuals
Implementation of
measure/method, grantee
responsibility and
provider/subgrantee responsibility
actions specified in G.1 above
• Implementation of actions
specified in G.1 above
• Documentation that Ryan White
funds are not being used for
direct maintenance expenses or
any other costs associated with
privately owned vehicles, such
as lease or loan payments,
insurance, or license and
registration fees – except for
vehicles operated by
organizations for program
purposes
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
Carry out actions
specified in G.1 above
Carry out subgrantee
actions specified in G.1
above
HAB Policy
Notice 10-02
• Carry out actions
specified in G.1
above
• Clearly define the
prohibition against
expenditures for
maintenance of
privately owned
vehicles in RFPs,
contracts,
MOU/LOA, and/or
statements of work
including clarification
of the difference
between privately
owned vehicles and
vehicles owned and
operated by
organizations for
program purposes
• Carry out subgrantee
actions specified in G.1
above
HAB Policy
Notice 10-02
58
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
8. Syringe Services: No use of
Ryan White funds shall be
used to carry out any
program of distributing sterile
needles or syringes for the
hypodermic injection of any
illegal drug
9. Additional Prohibitions: No
use of Ryan White Funds for
the following activities or to
purchase these items:
• Clothing
• Funeral, burial, cremation or
related expenses
• Local or State personal
property taxes (for residential
property, private automobiles,
or any other personal property
against which taxes may be
levied)
• Household appliances
• Pet foods or other nonessential products
• Off-premise
social/recreational activities or
payments for a client’s gym
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
Implementation of
measure/method, grantee
responsibility and
provider/subgrantee responsibility
actions specified in G.1 above
Documentation that Ryan White
funds are not being used for
programs related to sterile
needles or syringe exchange
for injection drug use.
• Carry out actions
specified in G.1
above
• Clearly define the
prohibition against
the expenditures for
syringe and sterile
needle exchange in
RFPs, contracts,
MOU/LOA, and/or
statements of work
• Carry out subgrantee
actions specified in G.1
above
Consolidated
Appropriations
Act 2012,
Division F, Title
V, Sec. 523
• Carry out actions
specified in G.1
above
• Develop and
implement a system
to review and
monitor subgrantee
program activities
and expenditures
and ensure a similar
system to review
and monitor grantee
expenditures
• Carry out subgrantee
actions specified in G.1
above
• Implementation of
measure/method, grantee
responsibility and
provider/subgrantee
responsibility actions specified
in G.1 above
• Review and monitoring of
grantee and subgrantee
activities and expenditures to
ensure that Ryan White funds
are not being used for any of the
prohibited activities
Ronald
Valdiserri
Letter
3/29/2012
Dr. Parham
Hopson Letter
1/6/2012
HAB Policy
Notice 10-02
59
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
Documentation that the CEO has
established a mechanism to
allocate funds that includes an HIV
Health Services Planning Council
with the membership and roles and
responsibilities specified in the
legislation
Ensure the CEO
understands the role of
the Planning Council,
the membership
requirements, and the
Planning Council’s
responsibility for setting
priorities and allocating
resources
N/A
PHS ACT
2602 (a)(2)
Participate in the Statewide
Coordinated Statement of Need
process initiated by the State, and
the services provided under the
EMA/TGA’s comprehensive plan
are consistent with the SCSN
Ensure the participation N/A
of the Part A program in
the SCSN process by
attending meetings,
reviewing drafts, joint
planning and alignment
of comprehensive plans
PHS ACT
2605 (a)(8)
membership
• Purchase or improve land, or
to purchase, construct, or
permanently improve (other
than minor remodeling) any
building or other facility
• Pre-exposure prophylaxis
Section H:
Chief Elected Official
(CEO) Agreements &
Assurances
1.
Planning:
a. Establishment of a
mechanism to allocate funds
and an HIV Health Services
Planning Council that meets
legislatively specified
requirements
Note: Certain TGAs are exempt
from this requirement
b. Participation in the Statewide
Coordinated Statement of
Need (SCSN) process
initiated by the State, and
assurance that the services
provided under the
EMA/TGA’s comprehensive
plan are consistent with the
SCSN
60
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
2.
Access to Care
a. Intergovernmental
agreements (IGAs) to be
established and maintained
with the Chief Elected
Officials (CEOs) of the
political subdivisions in the
EMA/TGA that provide HIVrelated health services and
account for no less than 10%
of AIDS cases diagnosed in
the EMA or TGA over the last
five years
b. Maintenance of appropriate
referral relationships with
entities considered key points
of access to the healthcare
system for the purpose of
facilitating early intervention
services for HIV-positive
individuals
c. Participation in an
established HIV community-
Performance Measure/
Method
Grantee
Responsibility
Documentation that
intergovernmental agreements are
in place with the Chief Elected
Officials of the political subdivisions
in the EMA/TGA that provide HIVrelated health services and account
for no less than 10% of AIDS cases
diagnosed in the EMA or TGA over
the last five years
Have on file IGAs with
the CEOs of applicable
political subdivisions
N/A
PHS ACT
2602 (a)(2)(AB)
Documentation of written referral
relationships with entities
considered key points of access to
the healthcare system for the
purpose of facilitating early
intervention services for individuals
diagnosed as being HIV positive
• Work with the
Planning Council to
identify key points of
entry using needs
assessment process
• Require
development and
maintenance of
written referral and
linkage agreements
between Ryan White
providers and key
points of entry
• Monitor the use of
referral and linkage
agreements by
funded providers
• Award program
funds to community-
• Obtain written referral
and linkage
agreements with key
points of entry, and
make these
agreements available
for review by the
grantee upon request
• Develop a mechanism
to track referrals from
these key points of
entry and linkages to
care
PHS ACT
2605(a)(3)
• Assurance that entities that
receive Part A funds will
Provider/Subgrantee
Responsibility
Source
Citation
N/A
61
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
based continuum of care, if
such continuum exists within
the EMA/TGA
Performance Measure/
Method
Grantee
Responsibility
participate in an established HIV
continuum of care if such
continuum exists within the EMA
or TGA
• Work carried out with the
Planning Council to describe
and analyze the current
continuum of care and identify
and implement for improving it,
based on of development of the
comprehensive plan for the
EMA/TGA
based not-for-profit
organizations or
public agencies,
where such entities
exist
• Work with the
Planning Council
and area providers
in developing or
enhancing a
continuum of care;
this includes
collaboration with
the Planning Council
to develop and
update the
comprehensive plan
for the EMA/TGA,
which involves
describing and
analyzing the current
continuum of care
and identifying and
implementing
actions to improve it
• Include language in
RFPs, contracts,
MOU/LOA and/or
statements of work
language regarding
access to care
regardless of ability
to pay and/or current
Provision of Part A- funded
• Documentation that the
HIV primary medical care and
EMA/TGA is funding HIV
support services, to the
Primary medical care and
maximum extent possible,
support services
without regard to either:
• Documentation that agency
• The ability of the individual to
billing and collection policies
pay for such services, or
and procedures are in place that
• The current or past health
do not:
d.
Provider/Subgrantee
Responsibility
Source
Citation
PHS ACT
2605 (a)(5)
N/A
PHS ACT
2605 (a)(7)(A)
62
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
conditions of the individuals to
be served
Performance Measure/
Method
Grantee
Responsibility
o Deny services for nonpayment
o Deny services for inability to
produce income
documentation
o Require full payment prior to
service
o Include any other procedure
that denies services for nonpayment
o Permit denial of services due
to pre-existing conditions
o Permit denial of services due
to non-HIV-related conditions
o Provide any other barrier to
care due to a person’s past
or present health condition
or past health
condition, and
requirements
regarding client
eligibility criteria and
use of fees and
sliding fee scales
Review agency’s
billing, collection, copay, and sliding fee
policies and
procedures to
ensure that they do
not result in denial of
services
Review agency
eligibility and clinical
policies
Investigate any
complaints against
the agency for denial
of services
Review files of
refused clients and
client complaints
Investigate any
complaints of
subgrantees
dropping high risk or
high cost clients
including “dumping”
or “cherry picking” of
patients
•
•
•
•
•
Provider/Subgrantee
Responsibility
Source
Citation
63
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
e. Provision of Part A-funded
Documentation that:
• Specify in RFPs,
HIV primary medical care and • Part A funded HIV primary
contracts,
support services in settings
medical care and support
MOU/LOA, and/or
that are accessible to lowservices are provided in a facility
statements of work
income individuals with HIV
that is accessible
expectations that
disease
services be provided
• Providers have in place policies
in settings that are
and procedures that provide
accessible to lowtransportation if facility is not
income individuals
accessible to public
with HIV disease
transportation
• Inspect service
• No provider policies dictate a
provider facilities for
dress code or conduct that may
ADA compliance,
act as a barrier for low-income
and location of
individuals
facility with regard to
access to public
transportation
• Review policies and
procedures for
providing
transportation
assistance if facility
is not accessible by
public transportation
f. Provision of a program of
Review documents
• Use of informational materials
outreach efforts to inform
indicating activities for
about agency services and
low-income individuals with
eligibility requirements including: promotion and
HIV disease of the availability
awareness of the
o Brochures
of services and how to
availability of HIV
o Newsletters
access them
services
o Posters
o Community Bulletins
o Any other types of
promotional materials
Provider/Subgrantee
Responsibility
Source
Citation
PHS ACT
2605 (a)(7)(B)
Maintain file documenting
agency activities for the
promotion of HIV services
to low-income individuals,
including copies of HIV
program materials
promoting services and
explaining eligibility
requirements
PHS ACT
2605 (a)(7)(C)
64
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
3. Expenditure and Use of
Funds
a. Compliance with statutory
requirements regarding the
timeframe for obligation and
expenditure of funds, and
with any cancellation of
unobligated funds
Performance Measure/
Method
• Documentation that any funded
awareness activities target
specific groups of low-income
individuals with HIV disease to
inform them of such services
Documentation that grantee has
complied with statutory
requirements regarding the
timeframe for obligation and
expenditure of funds, and with any
cancellation of unobligated funds
Grantee
Responsibility
• Establish systems to
ensure that formula
funds are spent first
and to maximize
timely expenditure of
funds by providers to
meet identified
service needs
• Ensure that
providers
understand the
importance of timely
expenditures and
reporting and their
responsibility for
informing the
grantee of expected
under-expenditures
• Work with the
Planning Council to
ensure an efficient
and timely
reallocations
process
• Provide timely and
accurate carryover
requests
• Comply with
Provider/Subgrantee
Responsibility
• Inform the grantee of
any expected underexpenditures as soon
as identified
Source
Citation
PHS ACT
2603 (c)
65
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
b. Expenditure of program
funds in compliance with
priorities established by the
HIV Health Services Planning
Council
Note: Certain TGAs are exempt
from this requirement
c. Expenditure of funds for core
medical services, support
services approved by the
Secretary of HHS, and
administrative expenses only
Performance Measure/
Method
• Documentation that actual
contracting and expenditure of
Part A funds is consistent with
the program priorities and
allocations established by the
Planning Council and submitted
to HRSA/HAB
• Review of the Planning
Council’s letter regarding
compliance, as submitted as
part of the annual Part A
application
Documentation of the grantee’s
expenditure of funds for core
medical services, support services
approved by the Secretary of HHS,
and administrative expenses only
Grantee
Responsibility
unobligated balance
requirements
• Comparison of
actual contracted
amounts of program
funding by service
category with the
revised list of
priorities and
allocations adopted
by the Planning
Council following
each year’s grant
award
• Review of the letter
from the Chair or
Co-Chairs of the
Planning Council
concerning whether
funds were
contracted to service
categories as
specified by the
Planning Council
• Establish and
maintain systems
and procedures that
ensure that funds
are used only for
permitted activities
• Ensure that
subgrantees
Provider/Subgrantee
Responsibility
Source
Citation
N/A
PHS ACT
2603 (d)
N/A
PHS ACT
2604 (a)
66
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
understand and are
required to use
funds only for
allowable service
categories
• Ensure that activities
carried out within
each service
category meet
HRSA definitions
and are categorized
and reported
appropriately
d.
Expenditure of not less than
75% of service dollars for
core medical services, and
expenditure of not more than
25% of service dollars for
support services that
contribute to positive clinical
outcomes for individuals with
HIV/AIDS, unless a waiver
from this provision is
obtained
Review of budgeted allocations
and actual program expenses to
verify that::
• The grantee has met or
exceeded the required 75%
expenditure on HRSA-defined
core medical services
• Aggregated support service
expenses do not exceed 25%
of service funds
• Support services are being
used to help achieve positive
medical outcomes for clients
• These requirements are met,
unless a waiver has been
obtained
•
Work with the
Planning Council to
ensure that final
allocations meet the
75%-25%
requirement
• Monitor program
allocations,
subgrantee
agreements, actual
expenditures, and
reallocations
throughout the year
to ensure at least
75% percent of
program funds are
expended for
HRSA-defined core
medical services
N/A
PHS ACT
2604(c)(3),
2604(d)
67
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
and no more than
25% percent of
program funds are
expended for HHSapproved support
services
• Require subgrantee
monitoring and
financial reporting
that documents
expenditures by
program service
category
• Maintain budgets
and funding
allocations,
subgrantee award
information, and
expenditure data
with sufficient detail
to allow for the
tracking of core
medical services
and support
services expenses
• Document and
assess the use of
support service
funds to
demonstrate that
they are contributing
to positive medical
outcomes for clients
68
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
• If a waiver is
desired, certify and
provide evidence to
HRSA/HAB that all
core medical
services funded
under Part A
program are
available to all
eligible individuals
in the area through
other funding
sources
e. Use of grant funds each
fiscal year for each of the
populations of women,
infants, children and youth,
not less than the percentage
constituted by the ratio of the
population in such area with
HIV/AIDS to the general
population in such area with
HIV/AIDS, unless a waiver
from this provision is
obtained
Documentation of :
• What percent each of the
specified populations constitutes
of the total AIDS population
• The amount and percent of Part
A program funds that are being
used to serve each of these
populations
• Whether the proportion of Ryan
White Part A funds being used
for each of the specified
populations meets legislative
requirements
• Funds from other sources (such
as Ryan White Part D) that are
being used to meet the needs of
these populations
• A waiver request, with
justification, if other funds are
• Prepare and submit
the annual WICY
Report
• Submission of a
WICY Waiver when
needed
N/A
PHS ACT
2604(f)(A)
69
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
f.
Performance Measure/
Method
believed to be meeting the
needs of any of these
populations
Compliance with legislative
Documentation that funded
requirements regarding the
providers providing MedicaidMedicaid status of providers: reimbursable services either:
funded providers of
• Are participating in Medicaid,
Medicaid-reimbursable
certified to receive Medicaid
services must be participating
payments, and using Medicaid
in Medicaid and certified to
funds whenever possible to
receive Medicaid payments
cover services to people living
or able to document efforts
with HIV disease
under way to obtain such
• Are actively working to obtain
certification.
such certification
g. Maintenance of Effort (MOE),
which includes the following:
• Funds to be used to
supplement, not supplant,
local funds made available in
the year for which the grant is
awarded to provide HIVrelated services to individuals
with HIV disease
• Political subdivisions within
the EMA/TGA to maintain at
Documentation of the grantee’s
Maintenance of Effort, including
submission of non-Ryan White
amounts allocated and assurances
that:
• Part A funds will be used to
supplement, not supplant, local
funds made available in the year
for which the grant is awarded
• Political subdivisions within the
EMA/TGA will maintain at least
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Specify in RFPs,
•
contracts, MOU/LOA,
and/or statements of
work that providers
receiving Part A funding
to provide Medicaidreimbursable services
are required to seek
•
certification to receive
Medicaid payments or
to describe current
efforts to obtain
certification
• Maintain
documentation of
each provider’s
Medicaid certification
status
Collect and submit the
following MOE
information to
HRSA/HAB annually:
• A list of core medical
and support
services, budget
elements that will be
used to document
MOE in subsequent
grant applications
Maintain on file
documentation of
Medicaid Status and
that the provider is
able to receive
Medicaid payments
Source
Citation
PHS ACT
2604(g)
Document efforts and
timeline for
certification if in
process of obtaining
certification
N/A
PHS ACT
2605(a)
HAB Policy
Notice 11-02
70
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
•
•
h.
•
•
i.
least their prior fiscal year’s
level of expenditures for HIVrelated services for individuals
with HIV disease
EMA/TGA will not use funds
received under Part A in
maintaining the level of
expenditures for HIV-related
services as required in the
above paragraph
Documentation of this
maintenance of effort to be
retained
Procedures in place to
ensure that services are
provided by appropriate
entities:
Program services to be
provided by public or nonprofit
entities, or by private for-profit
entities if they are the only
available provider of quality
HIV care in the area
Providers and personnel
providing services expected to
meet appropriate State and
local licensure and
certification requirements
Funded services to be
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
their prior fiscal year’s level of
• A description of the
expenditures for HIV-related
tracking system that
services
will be used to
document these
• The EMA/TGA will not use funds
elements
received under Part A in
maintaining the level of
• Budget for
expenditures
EMA/TGA
contributors
• Tracking/accounting
documentation of
actual contributions
• Documentation that program
services are being provided by
public or nonprofit entities
unless private for-profit entities
are the only available provider of
quality HIV care in the area
• Review of providers to ensure
that the entities and the
individuals providing services
have appropriate licensure and
certification, as required by the
State and locality in which the
provider is operating
Documentation that funded Part A
• Review and monitor
the licensing and
certification of
provider entities and
staff to ensure they
are valid and
appropriate
• Provide
documentation of
situations in which
private for-profit
entities are the only
available provider of
quality HIV care in
the area
• Have for-profit
justification available
for HRSA/HAB
review as needed
• Specify in RFPs,
N/A
PHS ACT
2605 (a)(10)
N/A
PHS ACT
71
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
integrated with other such
services and coordinated
with other available programs
(including Medicaid), so that
the continuity of care and
prevention services for
individuals with HIV is
enhanced
Performance Measure/
Method
Grantee
Responsibility
providers are expected to work
collaboratively with each other,
other available programs, and
prevention providers to enhance
continuity of care, as specified in
RFPs, contracts, MOU/LOA, and/or
statements of work and standards
of care
•
•
•
4.
Limitations on Use of
Funds
a. Expenditure of no more than
10% of the grant on
administrative costs, with
funds expended in
accordance with the
Documentation that :
• Grantee expenditures for
administrative costs do not
exceed 10% of grant funds
• Aggregate subgrantee
expenditures for administrative
purposes do not exceed 10% of
service dollars
•
Provider/Subgrantee
Responsibility
contracts,
MOU/LOA, and/or
statements of work
expectations for
service integration
and coordination
with other available
programs
Work with the
Planning Council
and providers to
improve linkages
and strengthen the
continuum of care
Encourage linkages
between Part A
providers and
prevention providers
Describe in the
annual grant
application the
continuum of care
and ways the entities
are integrated and
coordinated
Clearly define
• N/A
administrative cost
caps and allowable
activities in RFPs,
contracts,
MOU/LOA, and/or
statements of work
Monitor subgrantee
Source
Citation
2681 (d)
PHS ACT
2604 (h)(2),
2604 (h)(3)
72
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
legislative definition of
administrative activities, and
allocation of funds to entities
and sub-contractors such
that their aggregate
expenditure of funds for
administrative purposes does
not exceed 10% of those
funds
Performance Measure/
Method
Grantee
Responsibility
• Both grantee and subgrantee
administrative expenditures
meet the legislative definition of
administrative activities
•
b. Implementation of a Clinical
Quality Management (CQM)
program that meets HRSA
requirements, with funding
that does not exceed the
lesser of 5% of total grant
funds or $3 million
c. No use of Part A funds for
Documentation that:
• The grantee has implemented a
CQM program that that meets
HRSA requirements
• CQM funding does not exceed
the lesser of 5% of program
funds or $3 million
•
Documentation that no Part A
•
•
•
Provider/Subgrantee
Responsibility
expenditures to
ensure that:
o They meet the
legislative
definition of
administrative
activities
o In the aggregate
they do not
exceed 10% of
service dollars
Identify and describe
all expenses within
grantee budget that
are categorized as
administrative costs,
and ensure that such
expenses do not
exceed 10% of the
Part A grant
Develop and
• N/A
implement a CQM
plan
Develop a CQM
budget and
separately track
CQM costs
Provide a budget
and a financial report
to HRSA that
separately identify all
CQM costs
Specify in RFPs,
• N/A
Source
Citation
PHS ACT
2604 (h)(5)
PHS ACT
73
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
construction or to make cash
payments to recipients of
services
d. No use of Part A funds to pay
for any item or service that
can reasonably be expected
to be paid under any State
compensation program,
insurance policy, or any
Federal or State health
benefits program (except for
programs related to Indian
Health Service) or by an
Performance Measure/
Method
funds are used for construction or
to make cash payments to
recipients of services
Documentation and certification
that no Part A funds have been
used to pay for any item or service
that could reasonably be expected
to be paid for under any State
compensation program, insurance
policy, or Federal or State health
benefits program (except for
programs related to the Indian
Health Service) or by an entity that
Grantee
Responsibility
Provider/Subgrantee
Responsibility
contracts,
MOU/LOA, and/or
statements of work
the requirement that
no Part A funds be
used for construction
and that no funds be
used to make cash
payments to
recipients of services
[See Section F.5,
Direct Cash
Payment]
• Document grantee
costs and ensure
that no funds are
used for
construction; if the
grantee is also a
service provider,
ensure that no Part
A funds are used for
cash payments
N/A
• Maintain
documentation that
all costs that can be
paid under any State
compensation
program, insurance
policy, or federal or
State health benefits
program (except for
programs related to
Source
Citation
2604 (i)
PHS ACT
2604(c)(1-2)
74
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
entity that provides health
services on a prepaid basis
Performance Measure/
Method
provides health services on a
prepaid basis
e. Ryan White Part A funds
cannot be used to support
AIDS programs or materials
designed to promote or
encourage, directly,
intravenous drug use or
sexual activity, whether
homosexual or heterosexual
5. Miscellaneous
a. Compliance with the statutory
requirements regarding the
imposition of charges for
services, for those providers
who charge for services
[See Section G.I, Drug Use and
Sexual Activity]
b. Submit to the lead State
agency under Part B, audits
consistent with Office of
Management and Budget
Documentation that the EMA/TGA
is submitting audits consistent with
OMB A-133 to the Part B lead
agency every two years
Refer to fiscal monitoring standards
Grantee
Responsibility
the Indian Health
Service) or by an
entity that provides
health services on a
prepaid basis, have
been paid under
these programs and
not through use of
Part A funds
• Provide certification
that Part A funds
have not been used
in any of the
specified situations
[See Section G.I, Drug
Use and Sexual
Activity]
Provider/Subgrantee
Responsibility
N/A
• Refer to fiscal
• N/A
monitoring standards
Submit audits to State
Part B program every 2
years
Source
Citation
PHS ACT
2684
PHS ACT
2605 (e)
PHS ACT 2605
(a)(10)
75
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
(OMB) Circular A-133
regarding funds expended
under Part A, every two years
Section I:
Minority AIDS Initiative
1. Reporting
a. Submission of an Annual Plan
60 days after the budget start
date or as specified in the Notice
of Award that details:
• The actual award amount
• Anticipated number of
unduplicated clients who will
receive each service
• Anticipated units of service
• Planned client-level outcomes
for each minority population
served under the Minority
AIDS Initiative (MAI)
b. Submission of an Annual
Report due January 31 of
the year following
completion of the MAI fiscal
year
Documentation that the grantee
has submitted an MAI Annual Plan
60 days after the budget start date
that contains required elements
and meets HRSA/HAB reporting
requirements
Documentation that the grantee
has submitted an Annual Report on
MAI services that includes:
• Expenditures
• Number and demographics of
clients served
• Outcomes achieved
• Prepare and submit
• Establish and maintain
an MAI Annual Plan
a system that tracks
with specified
and reports the
content that meets
following for MAI
HRSA/HAB reporting
services:
requirements
o Dollars expended
o Number of clients
• Ensure that provider
served
contracts contain
o
Units of service
clear reporting
overall and by race
requirements that
and ethnicity,
include funds spent,
women, infants,
units of service
children, youth
provided, and cliento Client-level
level outcomes
outcomes
within each minority
population served
under the initiative
• Prepare and submit
• Maintain a system to
a year-end report
track and report MAI
documenting
expenditures, the
expenditures,
number and
number and
demographics of
demographics of
clients served, and the
clients served, and
outcomes achieved
the outcomes
• Provide timely data to
achieved
the grantee for use in
• Ensure that provider
preparing the Annual
contracts include
Report
Part A Minority
AIDS Initiative
(MAI)
Reporting
Instructions
Part A Minority
AIDS Initiative
(MAI)
Reporting
Instructions
76
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
Performance Measure/
Method
Grantee
Responsibility
Provider/Subgrantee
Responsibility
Source
Citation
clear reporting
requirements
Section J:
Data Reporting
Requirements
1. Submission of the Ryan
White HIV/AIDS Program
Services Report (RSR),
which includes three
components: the Grantee
Report, the Service Provider
Report, and the Client Report
Documentation that the EMA or
TGA has submitted the annual
online Grantee Report and that it
includes a complete list of service
provider contracts and the services
funded under each contract
a. Submission of the online
Grantee Report
b. Submission of the on-line
service providers report
Documentation that all service
providers have submitted their
sections of the online service
providers report
• Review the
EMA/TGA’s
organization’s
information for
accuracy
• Review and if
necessary correct
the pre-filled list of
funded contractors
and the list of the
contracted services
for each provider
• Submit the grantee
report electronically
by the deadline
• Include contract
language requiring
providers and
subgrantees to meet
the reporting
requirements
N/A
• Report all the Ryan
White Services the
provider offers to
clients during the
funding year
• Submit both interim
Ryan White
HIV/AIDS
Program
Services
Report
Instruction
Manual
Ryan White
HIV/AIDS
Program
Services
Report
Instruction
Manual
77
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013
Standard
c. Submission of the on-line
client report
Performance Measure/
Method
Documentation that all service
providers have submitted their
sections of the online client report
Grantee
Responsibility
• Ensure providers are
entering client-level
data, timely,
accurately and
completely.
Provider/Subgrantee
Responsibility
and final reports by the
specified deadlines
• Maintain client-level
data on each client
served, including in
each client record
demographic status,
HIV clinical information,
HIV-care medical and
support services
received, and the
client’s Unique Client
Identifier
• Submit this report
online as an electronic
file upload using the
standard format
• Submit both interim
and final reports by the
specified deadlines
Source
Citation
Ryan White
HIV/AIDS
Program
Services
Report
Instruction
Manual
78
HRSA/HAB Division of Metropolitan HIV/AIDS Programs
Program Monitoring Standards – Part A
April 2013